Understanding Barriers to Toileting

Many children with Autism Spectrum Disorder (ASD) or other Developmental Disabilities (DD) experience barriers with toileting due to internal challenges, external environmental factors, or a combination of both.⁴ Let’s explore some common barriers…

Common Barriers to Toileting

• Sensory Sensitivities
  • Some children experience the bathroom very differently because of how their senses work. Some children may be very aware (over-responsive) of things like sounds, lights, smells, or how things feel, while others may barely notice them (under-responsive).⁴ For example, the loud sound of a toilet flushing, bright lights, the smell of #1 and #2, or even the feeling of a cold seat can be uncomfortable, or barely noticeable! These sensory differences may lead to fear, discomfort, or even refusal to use the toilet.
• Interoception (Body Awareness)
  • Some children struggle to notice the internal signals their body sends, like the feeling of needing to use the bathroom. This sense is called interoception. Challenges with interoception are common in children with autism and often lead to frequent accidents or confusion about when to go to the bathroom.¹⁰
• Transition and Routine Disruption
  • Children with disabilities often have difficulty with transitioning away from an activity or shifting attention. Predictable routines help children feel safe and regulated, so change may be challenging. Transitioning from a preferred routine or activity, especially in busy environments like the classroom, can lead to interfering behaviors and accidents when not properly supported.¹¹
• Behavioral Challenges
  • Interfering behaviors (e.g. biting, hitting, etc.) are common during toilet training. These are typically connected to factors like sensory sensitivities, communication barriers, or difficulty coping with change.⁵
• Gastrointestinal (GI) Issues
  • Children with autism typically experience higher rates of chronic GI symptoms that may interfere with toilet training.¹² This can include symptoms like constipation or diarrhea, which can make toileting painful, frustrating, and unpredictable.⁴
• Communication Barriers
  • Children with developmental disabilities may have delays with their verbal communication, making it difficult to express the need to use the bathroom. This can be frustrating for both child and caregiver. Communication strategies, such as pictures or simple signs, can help lead to success.¹³
• Cognitive Delays
  • Children with cognitive delays often experience challenges with executive functioning. This can include skills like attention, memory, planning, problem-solving, and more. Cognitive delays may make it harder to learn a new toileting routine, follow multi-step tasks, recognize body cues, or adapt to changes.¹⁴
• Fine and Gross Motor Skill Development
  • Toileting involves a range of fine and gross motor skills that can be challenging for children with motor delays. Fine motor skills are small movements using the hands and fingers, while gross motor skills are larger movements using the arms, legs, and core.^14,20
    • Fine motor tasks include grasping toilet paper, managing clothing, and wiping require hand and finger coordination.
    • Gross motor skills such as sitting, standing, balancing, and core strength.