Resisting Toilet Training

As toddlers and young children grow into teens and young adults, family members, teachers, and other caregivers become more and more concerned about resistance to toilet training. Changing a soiled diaper for a five-year-old is only a minor inconvenience, but changing a soiled diaper for a twenty-five-year-old can be quite a challenge. Why do some people with autism resist toilet training?

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The reasons behind resisting toilet training vary greatly. It is certainly helpful to take time to determine the root cause(s) of the resistance. When we know the barriers, we are more able to develop an effective strategy for helping our friends with autism develop this critical self-help skill.

Some people with autism do not notice the cues our bodies provide in advance. In some cases, people may notice the discomfort, but not recognize the discomfort is a signal that should not be ignored. Some individuals cannot effectively communicate their need to use the restroom, so they have occasional accidents. Some are not motivated to move beyond the usual method of having a bowel movement in a diaper. Some individuals do not seem to notice or care if they have a toileting accident. Some people with autism strongly resist changes in routine, even if sticking with a routine results in soiled pants. Some people are being purposefully defiant, while others thrive on the attention and reaction of adults around them when they have an accident. And some people with autism with extreme auditory sensitivities avoid toilets and bathrooms at all costs because of the sudden loud noises.

An articulate adult with autism shared these thoughts after being assured I would protect her identity. My friend wrote, “I know this sounds very bizarre, but the thought of sitting on a toilet is horrifying to me. I guess it is similar to a young child imagining monsters under the bed. To me, a toilet is like a loud, gurgling, bottomless pit. I feel as if I will be sucked down into oblivion if I sit on a toilet. As strange as this seems, it is easier for me to wear adult diapers, changing them as soon as I can after a bowel movement, than to tolerate sitting on a toilet.”

Another adult shared a surprising insight about diapers. He said he had never told anyone about his strong preference for snug, tight-fitting underwear, a preference that paralleled his overwhelming need for deep pressure, tight-fitting boots and clothing, and tightly wrapped covers when sleeping at night. My friend “confessed” that he wore adult diapers to help with the need for snugness. When other viable options such as compression sports shorts came on the market, he was able to make that switch.

TIP FOR THE DAY. Even if none of the scenarios mentioned above seem logical to us, we need to realize that individuals with autism do not always view the world through the same lens as more “neuro-typical” people.

NOTE TO READERS AND LISTENERS: I am Cathy Knoll, a board certified music therapist and long-time friend of many folks with autism. At we are committed to providing free, practical, everyday tips for making life better for people with autism. Feel free to send me a confidential email at with your thoughts or challenging situations or innovative solution. And don’t forget to check out our website for a wealth of ideas and a glimpse into the world of autism.

3 Responses to “Resisting Toilet Training”

  1. Carol 3 November 2009 at 11:24 am Permalink

    My son and daughter-in-law made the decision not to have my grandson circumcised even before he was born. Then, shortly after his first birthday, he was diagnosed with autism. He will soon be four. My son is looking ahead at what it will be like when he is older trying to clean and properly take care of his hygene. He thinks my grandson should be circumcised now. The daughter-in-law is still against it. However, she is willing to listen or read about the advantages of having this procedure done. I am not a advocate of having every boy circumcised, but in his case, I believe it should be done and the sooner the better. Do you have any literature or facts on the subject?
    Thank you,

  2. Cathy 4 November 2009 at 2:28 am Permalink

    Hello, Carol. I do not have literature or research on the subject readily available. Some parents of my students with autism have encountered similar issues. Some have chosen to proceed with circumcision and others have chosen not to do so. Most made their decisions based on consultation with their medical doctors about the pros and cons. Because the broad range in autism of abilities related to self-care and hygiene, it is often difficult to predict a person’s ability to take care of personal needs, or their interest in personal care.

  3. margie ferguson 16 November 2012 at 9:38 pm Permalink

    Does anyone know how to toilet train an adult with autism or know of any sites that may help. I have an adult patient with this problem and the family is really struggling with this. The patient is toileted every hour yet is incontinent in between time. The patient wears a brief. Any help would be appreciated. Thank you

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