Toilet Training and Autism

Initial enquiry about toilet training a boy with autism, who then went on to become a client (seen once only) and effectively toilet trained within a month!!


Dear Rebecca,
I am having trouble training my 4 year old boy who is mildly autistic. Due to his special needs toilet training in the past has been unsuccesful. He seems to be holding on when he has no underwear on whatsoever. Seems to have a fear of letting go on the toilet/potty.Please advise on what to do. I am willing to make an appointment to come and see you if needed.


Hi There,

Toilet training can be frustrating for everyone, and it happens for each child at different ages/stages and usually when they are ready. Often when a genuine fear of letting go on the toilet is involved intervention is required and it can be a very slow and steady process in order for them to overcome their fear of the toilet. Rewarding them just for sitting on the toilet and what we call doing practise poos and wees on the toilet is a good start. Just getting them familiar with the toilet, making it a safe place (posters on walls, books to read etc) and of course watching mum and dad and brothers and sisters going to the toilet (modelling) and taking their favourite toy to the toilet and getting the toy to do wee on the toilet and get a reward for it is encouraging them that the toilet is safe and normal and everyone uses it and it is ok!!
Warm regards,

The following week the mother rang up to make an appointment:

I worked both with the mother and the son, and as I had suggested in the email, set them the task of doing “practise poos”, three times a day and prompts for using the toilet for wees.

After only 2 days: The mother reported via email as to her son’s progress:
Dear Rebecca, I can’t believe it but its working. Its taken us 2 days to get the gist of it but its working. He only does it sitting on the potty and the potty is in the toilet. I think its great, I hope you feel the same way. We’ll see what happens on the weekend.
Thanks a million

Before the weekend arrived, we received another email: Dear Rebecca, Hi how are you? We are well. I’m not sure if you believe in miracles but I am starting to believe in them now. He amazingly is not wanting even pullups on the potty now . He is doing wee(only) in the potty with no pullups or anything. I cannot believe it. This has happened 3 times in the last 3 days. I know its early days and we are not doing it every time (we still have accidents) but at least he is not so frightened to let go. My wish for the school holidays and while we are on holiday he will get this down to a T.

We thank you from the bottom of our hearts for the help you have given us with our problem. You are a Godsend.

Rebecca’s response:

That is fantastic news!!!!!!
You are all doing brilliantly. I’m not so sure about miracles either, I think it’s more to do with good training, excellent efforts by him and yourself and and perhaps the right timing. It’s fantastic that he is not frightened to go anymore, that is a huge breakthrough for him. Naturally, you have to expect some accidents, but they will gradually diminish over time providing the routine and structure still take place and rewards of course are still provided.

Well done to all of you and have a fantastic holiday.

Thanks for keeping me informed and I will hear from you when you get back for an update.
Warm regards,

Four weeks later, Rebecca sent an email for an update and received this response:

Dear Rebecca , Thanks for your e-mail. He is toilet trained now. He even stands up to do wees. He calls me when he has to do poos, but thats fine I’m sure he”ll go on his own soon enough. Still wears night pullup just in case, as he does wet every few days but I’m happy with that too. I can’t believe it that it happened so soon with your wonderful help and I tell everyone at special school about your services. Thanks a million Rebecca you’re an angel as I have told you before.

We’re using the ‘Boss of your Bladder’ book that you kindly gave us on our 5 year old and we’re meeting with good success.  Not there yet, but working on it!  My three year old girl is also proudly walking off to the toilet declaring that she is ‘the boss of the bladder’!!!

Hi There!

I have a 5½ year old who is continually wetting her pants during the day. Night time wetting is not a problem. (Three times in the last 6 months).

Her fluid intake is not very good and her main reason for the accidents is that she is too busy to stop what she is doing to go to the toilet.

However, she is very good at going to the toilets for poos. At school, she says she does not like to go to the toilet by herself.

She is a very cautious child and probably has some self-esteem issues. Unfortunately, I have become very frustrated and am getting angry with her when she wets, so I feel I’m adding to the problem.

Any suggestions? I am expecting my second child in five weeks and would dearly love to help her overcome the day wetting problems.


Frustrated Mum.

Response from Bladder and Bowel Specialist Psychologist.

Thanks for your email, we receive lots of emails just like yours and know how frustrating it can be for both parents and children. My name is Rebecca Gilmour and I am a psychologist who works with Dr Janet Hall, running the Boss of the Bladder program.

Unfortunately, day wetting is an issue that usually will not resolve itself without some type of intervention. Whether that be in the form of resources to read with your daughter and apply some of the strategies or perhaps the next step some professional help. The Boss of the Bladder Book, by Dr Janet Hall is a great book for helping children who wet both day and night. Be sure to read the section for children with your daughter as sometimes just having knowledge about what is going on can obviously help.

Daywetting seems quite a common problem particularly amongst girls within their first few years of school and also when there has/is significant changes going on in their lives, such as starting school, moving house, new baby etc…

I generally only work on a Monday and some Saturdays (by arrangement) and would be happy to work with your daughter and yourselves to assist her to become permanently dry during the day. This would involve an initial one hour appointment, in which we would set your daughter up with a behavioural plan. This would probably then follow fortnightly visits interspersed with weekly contact via phone or email. We are located in Richmond and you can email me on this address with any
further queries you may have, or contact me at the clinic on Mondays  only on 9429 1677.
Warm regards,
Rebecca Gilmour
Psychologist M.A.P.S
Boss of the Bladder Manager

A few weeks lapse without any further response from the frustrated
mum, so a follow up email is sent…

Just a quick check in to see how your daughter was getting on with achieving dry pants during the day. You emailed us for advice back in  June and so I was following up to see whether her being dry had improved. Look forward to hearing from you soon.

Response from Mother a day later.
I had a baby in July and not only has her day wetting gotten worse, she has been bed wetting as well. I’ve started to use ‘Dry-Nites’ to give us a break from changing bed linen and even put them on her during the day for a week at school. Problem is, if she’s got the dry-nites on, she makes no attempt at all to go to the toilet. We’re at our wit’s end as to what else to try! The GP and school nurse have said just give it time. I’m not sure what to try next.

Response from Psychologist.
Sorry to hear her day wetting has not improved and that she has begun wetting the bed as well. You must be exhausted!!

As your GP suggests, it’s probably not a good time to tackle the bedwetting just yet, as the birth of her new baby brother/sister is
still probably taking some adjustment (for everyone, but especially for her – this could be one of the reasons why she has begun
wetting). Unfortunately, if she continues to wear dry-nites, she is unlikely to resume becoming dry again, as it is a much different
sensation wetting in a nappy or pull-up as opposed to a bed. On a unconsciousness level, the child is unlikely to make the effort to be dry at night, if they know they have the security of a nappy/dry-nite.

There are some steps you could take in trying to help her become dry again at night (but without too much intervention).
1.) I’m not sure whether you have already purchased/read Dr Janet Hall’s book. “How You Can Be Boss of the Bladder”, but if you haven’t I would recommend you read the section for children with her.
2.) I would advise for the night-time wetting to purchase an absorbent bed mat especially designed for children for night wetting. There are two products which I am aware of, one is Slumberdry, the other is Conni. Both advertise in Melbourne’s Child each month, and have websites available. The mats are very absorbent and although obviously the child’s pjs get wet, as does the mat, it generally saves the sheets. The mat is easily washable and dryable.
3.) Depending on where things are at with your new baby and her adjustment to him/her, you could make an appointment to come and see me with her to work initially on getting her dry during the day, as that was the initial more pressing issue, and then possibly down the track if there has been no improvement with dry beds, we could work together on that.
Warm regards,
Rebecca Gilmour

The mother rang the following day and scheduled an appointment to
commence in the coming weeks.