Potty training an autistic child, by age
In short
Potty training an autistic child often takes longer than for other children, and there is no set age to start. Check for constipation first, then teach one small step at a time with pictures, regular bathroom sits and praise for trying. Child care centers that diaper young children generally must diaper older children with disabilities too, and toileting help can be written into an IEP or 504 plan.
Key points
- Potty training often takes longer for autistic children. There is no set age to start, and later is common.
- Check for constipation first. It is common in autistic children and can make potty training much harder.
- Use a picture sequence by the toilet, regular sits, easy clothes and praise. Never punish accidents.
- Staying dry at night often comes later. About 1 in 6 children still wet the bed at age 5.
- Child care centers that diaper young children generally must diaper older children with disabilities, at no extra charge.
- Toileting help can go in an IEP or 504 plan, and Medicaid may cover diapers when medically necessary.
On this page
- In short
- Is it normal for an autistic child to potty train later?
- When should I start, and what helps at each age?
- Why check for constipation first?
- How do I potty train my autistic child step by step?
- What if the bathroom upsets my child?
- What about nighttime?
- Can my child go to daycare, preschool or school in diapers?
- What does the research say?
- Where can I get help, including paying for diapers?
- Questions parents ask
- How this guide was made
- Sources
Is it normal for an autistic child to potty train later?
Yes. Potty training often takes longer for autistic children, and that is common and nothing to be ashamed of. In a large US study of 4 and 5 year olds, resistance to potty training was reported in 49% of autistic children, compared with 24% of children with other developmental delays and 8% of other children (Wiggins and others, 2022).
SPARK, a US autism research project, notes that a strong need for sameness, sensory differences and communication delays can all get in the way, and that constipation and other gut problems were linked to delays in that study. But later does not mean never: Elizabeth Cross, a clinical psychologist at the Kennedy Krieger Institute, told SPARK that "the vast majority of autistic children can be potty trained".
When should I start, and what helps at each age?
There is no set age, and you don't have to wait for your child to ask, but a few basic skills help. Cross told SPARK there is "no set age or developmental level for starting toilet training". She suggests looking for skills such as staying dry for one to two hours and following simple directions, and setting aside three to five days to focus on it when you begin.
Australia's Raising Children Network says autistic children usually show the same signs of readiness as other children, but the signs may appear later. It suggests talking to your child's pediatrician before you start, to rule out medical problems.
| Age | What often helps | Help to ask for |
|---|---|---|
| Under 3 | Short, relaxed sits and a picture sequence. Watch for basic skills, like staying dry for 1 to 2 hours | Your pediatrician, and early intervention if you're worried about development |
| 3 to 5 | Check for constipation, then regular sits, easy clothes and praise | Your pediatrician, your child care center, and a preschool IEP if your child needs one |
| 5 and older | Keep going, because many autistic children learn later. Build bathroom trips into the school day | An IEP or 504 plan, and the pediatrician if wetting is new or painful |
| Nighttime, any age | Often comes later than daytime, so focus on days first | The pediatrician if your child was dry and starts wetting again |
Good to know: If your child is under 3, you can contact your state's early intervention program yourself. The CDC says, "A doctor's referral is not necessary" (CDC, reviewed February 17, 2026).
Why check for constipation first?
Constipation is common in autistic children and can make potty training much harder, so check for it before you start. A meta-analysis found autistic children had nearly four times the odds of constipation compared with other children. Some autistic children eat a narrow range of foods, which can make constipation more likely (Raising Children).
Signs of constipation listed by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK, reviewed May 2018) include:
- fewer than two poops a week
- hard, dry or lumpy poop, or poop that is hard or painful to push out
- a swollen or bloated belly
- poop in the underwear that looks like diarrhea
- holding it in: standing on tiptoes and rocking back on the heels, clenching the bottom, or unusual, dance-like movements.
Children most often get constipated from holding in their poop, for example because they feel stressed about potty training or are afraid it will hurt (NIDDK).
See your child's pediatrician if you notice these signs. They may suggest changes to food and drinks, or medicine. NIDDK suggests a break from potty training until the constipation stops. Give or stop medicine only on the doctor's advice (NIDDK).
Get help now: See your child's pediatrician if constipation lasts more than 2 weeks or doesn't improve with home care, and promptly if your child loses skills they had, such as staying dry. See a doctor right away for blood in the poop, a swollen belly, constant belly pain, vomiting or weight loss (NIDDK). In an emergency, call 911 or go to the ER.
How do I potty train my autistic child step by step?
Teach one small step at a time, the same way every time, with pictures your child can follow.
- Check for constipation first, with your child's pediatrician.
- Keep a chart for a few days. Note the time and whether your child was wet, dry or had a poop. This shows the best times to try, and whether your child can stay dry for an hour or two.
- Make a picture sequence. Show each step: pants down, sit on the toilet, pee or poop, wipe, pants up, flush, wash and dry hands. Our toileting sequence printable is ready to use. Raising Children suggests putting it on the wall near the toilet and going over it together two or three times a day. If you can, use the pictures your child already sees at school or in early intervention (SPARK).
- Set up the bathroom. A footstool can help your child sit comfortably and feel stable, and a child seat can help if the big hole is scary. If changes are hard for your child, skip the potty chair and start on the toilet, so there is one less change later (Raising Children).
- Choose easy clothes, such as pants with an elastic waist. Washable training underwear can help your child notice when they are wet (Raising Children).
- Sit at the same times each day, such as after meals, based on your chart. Start with short sits and build up to no more than 5 minutes (Raising Children).
- Praise trying, not just success. Some children like clapping or a thumbs up, while others prefer quiet praise (Raising Children). If you use a reward, SPARK suggests a favorite toy, snack or activity that your child only gets for potty training.
- Stay calm about accidents. SPARK advises helping your child change quickly and avoiding scolding. Never punish your child for accidents.
- Share the plan. Give your child care center or school a copy of the picture sequence and your routine, so the steps look the same everywhere.
If your child is non-speaking (some services say nonverbal) or uses few words, teach a simple way to tell you they need to go, such as a bathroom picture to hand over, a sign, or a button on their AAC system. Raising Children also suggests using clear, specific words, such as "sit on the toilet and pee". Our guide on whether your autistic child will talk explains signs, pictures and AAC.
What if the bathroom upsets my child?
SPARK notes that "bathrooms may feel cold, lights may be too bright, toilet paper may feel rough", and that flushing toilets and hand dryers can be loud and strange. Small changes can help.
| What bothers your child | Things to try |
|---|---|
| The flush | Warn your child it will be noisy and say why, let them practice flushing, or try headphones |
| Hand dryers | Paper towels, or a small towel from home |
| A cold floor or room | Socks, and keep the bathroom as warm as the rest of the home |
| Bright light | A softer bulb or a lamp |
| Rough toilet paper or strong smells | Softer paper, and unscented soap and wipes |
| Feeling unsteady | A child seat and a footstool, so feet are flat |
| New or public restrooms | Practice with a short story before you go |
Most of these ideas come from Raising Children and SPARK. Raising Children adds that unfamiliar toilets can cause accidents away from home.
What about nighttime?
It's fine to focus on the daytime first and keep using a diaper or pull-up at night. Wetting at night is more common than daytime wetting, and bedwetting is common in all children: about 1 in 6 children wet the bed at age 5, 1 in 8 at age 6 and 1 in 10 at age 7 (NIDDK, reviewed September 2017).
NIDDK says, "Loss of urine is almost never due to laziness, a strong will, emotional problems, or poor toilet training." So there is no need for blame. Constipation can also lead to wetting, which is one more reason to treat it (NIDDK). See your child's pediatrician if your child was dry but starts wetting again, and within 24 hours if wetting comes with pain or burning when peeing, or a fever (NIDDK).
Can my child go to daycare, preschool or school in diapers?
Often, yes. Most child care must follow the ADA, and public schools can write toileting help into an IEP or 504 plan.
Child care centers and the ADA
The Justice Department's guidance on the Americans with Disabilities Act (ADA) says: "Centers that provide personal services such as diapering or toileting assistance for young children must reasonably modify their policies and provide diapering services for older children who need it due to a disability" (ADA.gov, last updated February 2020, checked September 29, 2026). Some details matter:
- It generally applies when staff would not have to leave other children unattended.
- A center that never helps any child with toileting may not have to start, but it still cannot exclude your child for not being potty trained if other arrangements are possible, such as you coming in to change them.
- A center cannot charge extra for a service the ADA requires.
- The ADA covers almost all child care providers, even small home-based ones. Centers run by religious organizations, such as churches, are exempt, but a private center that only rents space from one generally is not.
- Government-run programs, such as Head Start, follow Title II of the ADA instead.
Public preschool and school: an IEP or 504 plan
If your child has or might need an IEP or 504 plan, ask for toileting help to be written into it. Under the rules for IDEA, an IEP must include measurable annual goals, "including academic and functional goals", and the services and supports your child will get (34 CFR 300.320). Using the toilet is an everyday functional skill, so it can be one of those goals. Under Section 504, schools must provide a free appropriate public education through "regular or special education and related aids and services" (34 CFR 104.33).
Ask for the plan to cover:
- who will help your child, and where, with privacy
- a schedule of bathroom trips, with the same pictures and words as at home
- a simple way for your child to ask to go
- spare clothes and supplies kept at school
- how staff will tell you about progress.
If your child doesn't have an IEP yet, you can ask the school district for an evaluation. It must be done within 60 days of your consent, or within your state's own timeline (34 CFR 300.301). These federal rules were in effect on September 29, 2026.
State rules differ: Each state sets its own eligibility rules for early intervention (ECTA), runs its own Medicaid program and has its own child care rules. The ADA still applies in every state. A Parent Center can explain your state's early intervention and school rules, for free.
What does the research say?
Potty training often takes longer for autistic children, but research on how to teach it is small.
- In an older survey of 100 families, learning to pee in the toilet took 1.6 years on average, and learning to poop in the toilet took 2.1 years. More than half (56%) had to be taught to go by themselves, rather than waiting to be taken (Dalrymple and Ruble, 1992).
- A pilot trial of 33 autistic children aged 3 to 6 compared two parent-led potty training plans, one using an app and a wetness alarm. Most families (84%) finished and followed the plans closely, but neither plan clearly did better on accidents or toilet use (Mruzek and others, 2019).
- A small study of video coaching from an occupational therapist enrolled 34 families of autistic children aged 2 to 8, and 25 finished. Parents reported improvements, but there was no comparison group (Little and others, 2023).
Evidence check: Picture sequences, regular sits, praise and treating constipation are advised by child health and autism organizations, but studies of potty training for autistic children are small. We found no large trials.
Where can I get help, including paying for diapers?
Start with your child's pediatrician, who can check for medical causes such as urinary tract infections (Cleveland Clinic).
| Who | How they can help |
|---|---|
| Pediatrician | Checking for constipation and other medical causes, and referrals |
| Occupational therapist (OT) | Seats, steps, clothes and sensory changes in the bathroom |
| Speech-language pathologist (SLP) | A way for your child to tell you they need to go |
| The IEP or 504 team (3 and older) | A written toileting plan at preschool or school |
Paying for diapers
If your child has Medicaid, ask about diapers or pull-ups. CMS's guide to EPSDT, Medicaid's benefit for under 21s, lists "incontinence supplies" among services covered when medically necessary (CMS, June 2014, checked September 29, 2026). Ask your child's pediatrician whether your child could qualify, and ask your state Medicaid program how to apply.
If your child doesn't have Medicaid, some states have routes called TEFRA or Katie Beckett that don't count parents' income for disabled children living at home (Georgia Medicaid is one example). 211 can point you to local help with bills.
Free helplines (checked September 2026)
- The Autism Society National Helpline, 1-800-328-8476, gives information and referral. It is not a crisis line.
- Parent Centers give free help with IEPs and 504 plans in every state.
- Protection and Advocacy agencies give free legal advocacy, including at school.
Questions parents ask
What age should an autistic child be potty trained?
There is no set age. A psychologist quoted by SPARK, a US autism research project, says there is no set age or developmental level for starting, and SPARK suggests looking for basic skills such as staying dry for one to two hours and following simple directions. Many autistic children train later: in a large US study, resistance to potty training was reported in about half of autistic 4 and 5 year olds. Later is common, not a failure.
My autistic child is 6 and still in diapers. Is it too late?
No. Elizabeth Cross, a psychologist at the Kennedy Krieger Institute, told SPARK that the vast majority of autistic children can be potty trained. In an older survey of 100 families, learning to pee in the toilet took 1.6 years and learning to poop in the toilet took 2.1 years, on average. Check for constipation with your pediatrician, then use a picture sequence, regular sits and praise, and ask for toileting help in your child's IEP or 504 plan.
Can a daycare refuse my child because they aren't potty trained?
Generally not. The Justice Department's ADA guidance says centers that diaper or help young children with toileting must reasonably change their policies and diaper older children who need it because of a disability, and cannot charge extra for services the ADA requires. A center that never helps any child with toileting may not have to start, but it still cannot exclude your child for not being potty trained if other arrangements can be made, such as a parent coming in to change them. Centers run by religious organizations are exempt.
Can you potty train a non-speaking autistic child?
Yes. Being non-speaking doesn't rule it out, although it may take longer. Give your child a simple way to tell you they need to go, such as a bathroom picture card to hand over, a sign, or a button on their AAC system, and use the same short words every time. Put a picture sequence by the toilet and schedule regular sits at the same times each day.
My child is scared of the flush. What can I do?
Australia's Raising Children Network suggests telling your child there will be a noisy flushing sound and explaining why, letting your child practice flushing, or using headphones if the noise is distressing. Go at your child's pace, and praise each small step, such as staying in the room while someone else flushes.
My child will only poop in a diaper. What should I do?
It can be a sign of constipation. Raising Children says an autistic child who avoids pooping may be constipated, and that refusing to poop can be a sign of distress, discomfort, pain, fear, sensory overload, confusion or communication difficulties. Ask your pediatrician to check for constipation first. Then make one small change at a time toward using the toilet, and ask an occupational therapist to help you plan the steps.
Will Medicaid pay for diapers for my autistic child?
It may. CMS's guide to Medicaid's benefit for children and young people under 21, called EPSDT, lists incontinence supplies among the services covered when medically necessary. Ask your child's pediatrician whether your child could qualify, and ask your state Medicaid program how to apply. If your child doesn't have Medicaid, some states have routes that don't count parents' income for disabled children living at home.
Is it normal for my 6 year old to wet the bed?
Yes. The National Institute of Diabetes and Digestive and Kidney Diseases says about 1 in 8 children wet the bed at age 6 and 1 in 10 at age 7, and that it is almost never due to laziness or poor potty training. See your pediatrician if your child was dry but starts wetting again, and within 24 hours if wetting comes with pain or burning when peeing, or a fever.
How this guide was made
- Written by
- The Rocks Make Pebbles editorial team, using the 20 sources listed below.
- How
- We researched the topic from US guidance, federal law and published research, drafted the guide with the help of AI tools, and checked it against its sources on September 29, 2026. Read our editorial policy.
- Professional review
- Not yet reviewed. This guide is waiting for review by a pediatric nurse or pediatrician. We will show their name and the date here once they have checked it.
- Last updated
- Next review due
- , or sooner if the rules or the research change.
- Spotted a problem?
- Email support@rocksmakepebbles.co.uk and tell us which guide. We fix mistakes quickly and list them on our corrections page.
Sources
- Toileting resistance among preschool-age children with and without autism spectrum disorder (Wiggins et al., Journal of Developmental and Behavioral Pediatrics) Europe PMC, 2022
- What to know about toilet training your child with autism SPARK, September 18, 2023
- Toilet training for autistic children: signs, strategies and challenges Raising Children Network (Australia), July 24, 2026
- Toilet training in children with autism spectrum disorder Cleveland Clinic, May 15, 2020
- Early intervention contacts by state Centers for Disease Control and Prevention, February 17, 2026
- Gastrointestinal symptoms in autism spectrum disorder: a meta-analysis (McElhanon et al., Pediatrics) Europe PMC, 2014
- Symptoms and causes of constipation in children National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), May 2018
- Treatment for constipation in children National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), May 2018
- Definition and facts for bladder control problems and bedwetting in children National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), September 2017
- Symptoms and causes of bladder control problems and bedwetting in children National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), September 2017
- Commonly asked questions about child care centers and the Americans with Disabilities Act U.S. Department of Justice (ADA.gov), February 28, 2020
- 34 CFR 300.320: Definition of individualized education program eCFR, September 25, 2026
- 34 CFR 104.33: Free appropriate public education (Section 504) eCFR, September 25, 2026
- 34 CFR 300.301: Initial evaluations eCFR, September 25, 2026
- Part C eligibility Early Childhood Technical Assistance Center (ECTA)
- EPSDT: a guide for states, coverage in the Medicaid benefit for children and adolescents Centers for Medicare & Medicaid Services, June 2014
- TEFRA/Katie Beckett Georgia Medicaid
- Toilet training and behaviors of people with autism: parent views (Dalrymple and Ruble, Journal of Autism and Developmental Disorders) Europe PMC, 1992
- A pilot investigation of an iOS-based app for toilet training children with autism spectrum disorder (Mruzek et al., Autism) Europe PMC, 2019
- A telehealth delivered toilet training intervention for children with autism (Little et al., OTJR) Europe PMC, 2023
Related guides
Words in this guide
- Sensory processing differences
- Early intervention (Part C)
- IEP (Individualized Education Program)
- 504 plan
- Non-speaking
- AAC (augmentative and alternative communication)
- IDEA (Individuals with Disabilities Education Act)
- OT (occupational therapist)
- SLP (speech-language pathologist)
- EPSDT
- TEFRA or Katie Beckett