Toilet Training Readiness in Autism: Are We Waiting Too Long to Start?
One of the most common questions I hear from families is, "How do I know if my child is ready for toilet training?"
It's a great question—but I sometimes worry we're asking the wrong one.
For years, parents and professionals have relied on checklists of "readiness signs": showing interest in the bathroom, staying dry for long periods, asking to use the toilet, wanting to wear underwear, following directions, telling adults when they need to go…the list goes on.
The tricky part is there isn't actually universal agreement on which of those signs matter, or how many a learner needs before it's appropriate to begin. Reviews of the research have identified more than 20 different readiness indicators, with little consensus among experts.
For autistic learners, this becomes even more complicated.
Physiological Signs of Toilet Training Readiness
Many traditional readiness signs depend on social motivation or language. Things like copying others, asking to wear "big kid" underwear, or telling an adult they need to use the bathroom may never develop in the same way they do for neurotypical children. If we wait for every item on a readiness checklist, some learners may never get the opportunity to learn an incredibly important life skill.
That doesn't mean readiness isn't important. It absolutely is. But we need to broaden how we define it. Instead of asking, "Does my child have every readiness sign?" I encourage families to ask: "Does my child have enough foundational skills for us to start teaching and are we ready to take steps to teach the skills needed to be successful in the bathroom?"
Although research has not established a specific set of readiness indicators for autistic learners, I generally place greater emphasis on physiological signs. For example, increasing bladder capacity demonstrated by larger urine voids and longer periods of dryness tell us the body is becoming more capable of successful toilet training. Those physiological changes may provide more useful information than whether a child shows interest in wearing underwear or imitates siblings in the bathroom.
Before beginning toilet training, it's also important to consider whether untreated constipation, urinary tract infections, pain, medication effects, or other medical concerns could interfere with success. Addressing these issues first can help create a stronger foundation for learning.
Prerequisite Skills
Another misconception is that every prerequisite skill must already be in place before training begins.
In reality, many of those skills can be taught as part of the toileting process. Sitting on the toilet, pulling pants up and down, washing hands, transitioning to the bathroom, communicating bathroom needs using speech or AAC, and following simple bathroom routines are all skills that often improve through instruction. For some learners, waiting until every prerequisite skill has been mastered may unnecessarily delay opportunities to teach those skills within the context of toileting.
Research also reminds us that delaying toilet training isn't always a neutral decision. Toilet training has gradually shifted later over the past several decades, and later training has been associated with increased financial costs for families, and greater environmental waste. Some studies have found associations between later toilet training and certain bladder and bowel concerns, although these relationships are likely influenced by multiple developmental and medical factors and should not be interpreted as evidence that delaying toilet training directly causes these difficulties. While every learner develops differently, waiting indefinitely "until they're ready" isn't always the most helpful path either.
Caregiver Readiness Matters Too
Readiness isn't only about the learner.
One of the biggest predictors of success is whether the adults are ready. Successful toilet training takes consistency across home, school, and other caregivers. Everyone doesn't have to do it perfectly, but everyone should be working toward the same goal using similar strategies. A learner who receives consistent support throughout the day is often much more successful than a learner who demonstrates every "readiness sign" but experiences an inconsistent approach.
Before getting started, caregivers may find it helpful to ask themselves a few questions:
Can we commit the time and consistency that toilet training requires?
Are parents, school staff, daycare providers, therapists, and other caregivers communicating regularly?
Is everyone prepared to respond to accidents and successes in a similar way?
Can we provide frequent opportunities to practice throughout the day?
Do we have a plan for weekends, vacations, or changes in routine?
If the answer to some of these questions is "not yet,“ it may mean the adults need a little more planning and coordination before beginning.
Rethinking Readiness
At the end of the day, toileting readiness isn't an all or nothing milestone. It's a continuum. Some learners may move through training quickly because they already have many foundational skills. Others may need more teaching and more support along the way. Both are okay.
The goal isn't to wait for the perfect moment. It's to recognize when a learner has enough of a foundation to begin, caregivers are prepared, and everyone is ready to start, support, and shape the skills that lead to greater independence.
Many parents have been encouraged to wait for a long list of readiness signs before beginning toilet training. While that guidance is well intentioned, some learners may never demonstrate every traditional sign. In those cases, focusing on foundational skills, caregiver readiness, and a thoughtful teaching plan may open the door to meaningful progress.
Beginning toilet training doesn’t mean rushing or forcing a learner through the process. Teaching should be individualized, respectful and responsive to the learner’s needs.
Interested in gathering more information on whether your learner is ready to start the toileting process? Check out our upcoming CEU on toileting readiness.
References:
Barutçu, A., Mete, B., Demirhindi, H., Barutçu, S., Kıdı, A., & Evliyaoğlu, N. (2024). Toilet training readiness scale for 0–5-year-old children: A new measurement tool based on a child-centred approach. Children, 11(9), Article 1149.
Kaerts, N. (2012). Studies on toilet training in healthy children: Including when to start, the use of readiness signs, current toilet training practices in day care and the relation between day care and parents (Doctoral dissertation, University of Antwerp). ProQuest Dissertations Publishing.
Kaerts, N., Van Hal, G., Vermandel, A., & Wyndaele, J.-J. (2012). Readiness signs used to define the proper moment to start toilet training: A review of the literature. Neurourology and Urodynamics, 31(4), 437–440.
Kaerts, N., Vermandel, A., Lierman, F., Van Gestel, A., & Wyndaele, J.-J. (2012). Observing signs of toilet readiness: Results of two prospective studies. Scandinavian Journal of Urology and Nephrology, 46(6), 424–430.