By Janie Thompson

Autism Spectrum Disorder (ASD) is a neurodevelopmental condition that begins in early childhood. A child with ASD can experience challenges in social communication and social interaction and restricted, repetitive patterns of behaviour, interests or activities as described in the DSM-V (Diagnostic and Statistical Manual of Mental Disorders). There are three levels of ASD. A child or person with Level 1 ASD requires support, Level 2 requires substantial support and Level 3 requires very substantial support. These requirements for support are reflected in their communication and behaviours.

A child with ASD has an increased chance of experiencing nocturnal enuresis (or bedwetting), daytime incontinence, faecal incontinence and constipation or bowel emptying conditions. As a result, a child with ASD needs more time, more support and a more structured approached to toilet training. There are great benefits to the child and their family and carers to offering that support. 

When supporting a child with ASD to achieve toilet training, consider the following (1)

Social communication

For children who struggle to communicate when they need to go to the toilet.

  • Use a structured time schedule with your child that includes toileting times, to remind or take your child to the toilet based around how frequently they need to pass urine or when they most commonly use their bowels

  • Use visual prompts or pictures in the toilet area to show the steps to toileting such as the Continence Foundation of Australia’s Girls and Boys Toileting Sequence Pictures 

  • Make learning about the steps to toileting and trying to use the toilet part of your child’s routine as early as possible

  • Keep an eye on your child’s bowel pattern and try to avoid any constipation.

Social-emotional communication

For children who struggle to understand where it is socially acceptable to pass urine or use their bowels, the social impact of incontinence and the need for privacy with toileting.

  • All toileting related activities involving your child should be done in the toilet environment, for example, changing pull ups, any cleaning up needed. This is to reinforce the relationship of urinating or having a bowel movement to the toilet

  • Use positive feedback with any steps to toileting your child has attempted or achieved, including toilet flushing, handwashing, pulling their underwear down and up

  • Use the particular interests of your child to encourage them to spend time on the toilet and develop a positive relationship with the toilet without being distracted

Restricted, repetitive behaviours

For children who want to use the toilet continually as a repetitive behaviour but do not have an overactive bladder.

  • Rule out overactive bladder. Speak to your child’s GP to start with

  • Offer positive reinforcement for the first or initial urination only

  • Offer your child activities of interest to them, to minimise repeat trips to the toilet.

Restricted diet 

For children with food textural issues resulting in a low fibre diet which may contribute to constipation.

  • Introduce new foods to your child slowly and steadily

  • Give positive reinforcement to your child for trying new foods

  • Offer food in your child’s preferred style, for example mashed or mixed with other foods that are accepted by them.

Sensory issues

For children who find the toilet environment distressing (bright lights, sound of flushing toilet, cold toilet seat).

  • Adjust the toilet environment to suit your child’s sensory preferences

  • Ensure your child can sit on the toilet with their feet well supported and in a comfortable position

  • Dress the child in clothing that is easy for your child to get on and off. 

Motor issues 

For children with coordination and fine motor skills challenges.

  • Use visual cues to help your child follow the steps to toileting, such as pictures of the steps

  • Use aids or equipment to suit your child to maximise their independence. An Occupational Therapist may be able to help with these

  • Try having your child focus on the last step in using the toilet and work backwards from there, such as starting with handwashing first.


The Foundation has resources to support parents and carers of a child living with a disability such as One Step at a Time – A parent’s guide to toilet skills for children with disability:

For general information on toilet training, please see the Foundation’s webpage:

  1. von Gontard, A et al. Neurodevelopment disorders and incontinence in children and adolescents: Attention-deficit/hyperactivity disorder, autism spectrum disorder and intellectual disability – A consensus document of the International Children’s Continence Society. Neurourol Urody 1-13; 2021.