Autistic Child Not Toilet Trained: Support for Ages 5 Upwards
If your child is still having wetting accidents or soiling accidents in the day or at night, you may have tried several approaches already. If your autistic child is not toilet trained yet, you may be wondering what is getting in the way.
This article is for parents of older children (5-17) who are still having toileting difficulties. Some autistic children become reliably toilet trained later than their peers. For some, wet nights can continue into the early teens, even when daytime toileting is well established.
There can be several reasons for this. Your child may find it difficult to notice signals from their bladder or bowel – this is known as interoception dificulties. They may also be sensitive to the toilet environment – for example bathrooms may seem echoey, or smelly, in a way that overwhelms their senses. Your child may find communication regarding going to the toilet difficult, or struggle with toiletting when there are changes to familiar routines.
Constipation can also contribute to wetting or soiling, while sleep can affect how easily your child wakes when they need the toilet. Understanding what may be contributing can help you work out what support your child needs.
Your GP can check for medical causes and advise whether further assessment is needed.
What may be making toileting difficult for an autistic child?
Toilet training involves much more than learning where to use the toilet. Your child needs to notice body signals, understand what they mean, manage the bathroom environment and follow several steps.
Autistic children can experience difficulties with some of these skills. The particular combination varies from child to child, so it is worth looking at what happens before, during and after toileting.
Difficulty noticing when they need the toilet
Interoception is the ability to notice signals from inside your body. These signals include hunger, thirst, pain and the feeling of a full bladder or bowel.
Some autistic children do not notice these signals until they become strong. Others may notice them but find it difficult to interpret what they mean.
Your child may also become deeply absorbed in an activity and miss early signals. Regular toilet opportunities can help while your child develops greater awareness.
Sensory differences around the bathroom
Bathrooms can contain many sensations that other people barely notice. Echoing sounds, strong smells, bright lighting, cold surfaces and the noise of flushing can all be difficult.
Some children may dislike the feeling of sitting on the toilet. Others may become distressed by the sound of the flush or the sensation of water.
Think about which parts of the bathroom your child finds difficult. Small changes to lighting, noise, temperature or seating may make the environment easier.
You can find more ideas in my article, understanding sensory processing in autism.
Communication and understanding
Your child may understand more than they can easily communicate. They may not know how to tell you they need the toilet, particularly when the need comes suddenly.
Toilet training also involves several steps. These might include stopping an activity, going to the bathroom, managing clothing, sitting, wiping, flushing and washing hands.
A child who manages some of these steps may still need support with others. Visual prompts can make the sequence more predictable and reduce the amount of spoken language needed.
Changes, routines and toilet anxiety
Many children find familiar routines reassuring. A change to the bathroom, toilet, school routine or usual sequence can therefore cause difficulties.
Some children also develop anxiety after painful constipation, a frightening flush or previous accidents. They may begin avoiding the toilet because they expect something unpleasant to happen.
This can create a cycle where avoiding the toilet makes accidents or constipation more likely. Understanding what your child is avoiding can help you decide where to start.
Constipation and other physical factors
Constipation is particularly important to consider when toileting difficulties include soiling. A child may withhold stool because passing it has become uncomfortable.
A full bowel can also put pressure on the bladder and contribute to wetting. This means constipation can sometimes affect both bowel and bladder control.
Arrange a GP appointment if your child has pain, frequent urination, unusual thirst, recurrent infections, significant constipation, soiling or a sudden change in toileting.
Your GP can check for physical causes and advise whether further assessment is appropriate. Local NHS children’s continence services may also assess daytime wetting, bedwetting and constipation.
Before an appointment, it can help to record accidents, bowel movements, drinks, toilet visits and possible triggers. This can give the clinician a clearer picture of what is happening.
Why might an older autistic child still wet the bed?
Night-time wetting is different from daytime toileting. Staying dry overnight depends partly on how much urine the kidneys produce and how the bladder behaves during sleep.
It also depends on whether your child wakes when their bladder is full. Some children develop this combination of skills later, including some autistic children.
Bedwetting can continue into later childhood and the early teenage years. If your child is still wetting the bed, it is worth discussing this with your GP rather than assuming they will simply grow out of it.
A boy coming out of his bathroom at home
How the body stays dry overnight
Several things work together to keep a child dry during sleep. The kidneys normally produce less urine overnight. This happens partly because the brain releases more vasopressin, also called antidiuretic hormone or ADH.The bladder also needs to store urine until morning. Your child then needs to wake, or respond appropriately, when their bladder becomes full.
If one or more of these processes develops later, bedwetting can continue. The reasons can vary considerably between children. Cambridge University Hospitals’ bedwetting information explains more about the factors involved.
Bedwetting alarms and desmopressin
If your child is still wetting the bed, there are treatments that can help. NICE (the National Institute for Health and Care Excellence) provides guidance for managing bedwetting in children and young people.
After advice about drinks and daytime toileting, NICE generally recommends a bedwetting alarm when the child and family can manage one. An alarm detects moisture and wakes the child when wetting begins. With repeated use, some children gradually learn to respond to their bladder signals during sleep. Progress is usually reviewed after around four weeks. If your child is responding, treatment can continue.
Desmopressin is a medicine that acts like the body’s natural vasopressin. It reduces the amount of urine produced overnight. It may be considered when rapid or short-term improvement is needed, such as for a school trip. It may also be considered when an alarm is unsuitable. Desmopressin needs to be prescribed and used according to professional advice. This includes specific guidance about fluid intake and safety.
NICE guidance on bedwetting gives further information about treatment options. You can also read parent-friendly desmopressin information.
Making nights easier while you work on bedwetting
Treatment does not need to be the only focus. Practical changes can make nights easier for everyone in the meantime. Keep the route to the toilet clear and make the bathroom easy to access. Waterproof bedding, spare pyjamas and continence products can also reduce disruption.
If your child has a sleepover or school trip, involve them in deciding what would make things easier. Older children may particularly value privacy and control over how accidents are managed.
Repeatedly waking your child to use the toilet is not usually a long-term solution. If bedwetting is also affecting sleep, you may find my article about support for an autistic teenager who is not sleeping helpful.
Practical toilet training support at home and school for ages 5 to 13
If you are wondering how to help your autistic child with toilet training at this age, start small. Aim for a routine your child can predict and gradually take ownership of.
Build a low-pressure routine at home and school
Begin with one or two predictable toilet visits each day within your daily routine, such as after meals. Use the same words and visuals each time. Social stories about using the toilet can also help.
Make the routine as easy to follow as possible. A footstool, comfortable clothing and a quieter bathroom may help if particular parts of toileting are difficult.
For example, an 8-year-old might use a timer before leaving home and after meals. A picture checklist can show clothing, sitting, bottom wiping, flushing and handwashing. Praise participation and effort, rather than focusing only on whether your child stays dry.
An autistic child who is still having toileting difficulties can take part fully at school when the adults around them use one clear plan. Share your child’s communication style, sensory triggers and helpful prompts with the SENCO and trusted school staff. Agree discreet toilet access, extra clothes kept at school, an individual toileting programme if useful, and a calm response to accidents.
Get the right support around your child
If toileting difficulties continue, your GP can advise about further assessment or referral to a local NHS continence service. ERIC is also a useful UK charity for bowel and bladder information. A private paediatrician, occupational therapist or clinical psychologist can offer more tailored input if it is affordable. Check the clinician’s qualifications and approach.
For wider help with sensory needs, anxiety and sleep, consider the Embracing Autism online course for parents. Seek further help if wetting persists, infections recur, your child has pain, severe constipation, marked thirst, sudden regression or distress.
What to do next
Toileting difficulties can have several causes, and your child may need support with more than one part of the process. Start by looking at what happens before, during and after accidents or toilet visits. This can help you identify whether body awareness, sensory differences, communication, routines, constipation or sleep are contributing.
If you are concerned about your child’s health or toileting has changed suddenly, speak to your GP. You can also work with school to make sure the same approach is used across settings.
The aim is not simply to achieve dryness as quickly as possible. It is to understand what your child needs and build greater independence over time.
Frequently asked questions
There is no single age that suits every autistic child. Many children gain daytime control in the early years, and night-time dryness often follows later. Autistic children may take longer, particularly when body awareness, sensory sensitivities or communication make toilet training harder. If your child is 5 or older and still having wetting accidents, ask your GP about a referral to a paediatrician
Refusal usually has a reason behind it. Sensory differences can make the noise, smell or feel of the toilet overwhelming. Your child may also struggle to notice body signals, feel anxious about flushing, or find it hard to stop an activity. Constipation and pain can make the toilet uncomfortable too, so a medical check is a helpful first step.
Help your child link body sensations to the toilet. Use simple words such as “your tummy feels full” or “you might need a wee”, offer regular toilet visits after meals and drinks, and use timers or a vibrating watch as reminders while awareness develops. ERIC has practical guidance on interoception and toileting.
A sudden change in a child who was previously dry needs a medical check. Constipation is a common cause, and urinary infections and other gastro-intestinal issues can also play a part. Frequent urination with unusual thirst should be checked promptly, as it can be linked to conditions such as diabetes. Big changes or stress can also affect toileting, so your GP can look at the whole picture.
Ask your GP for an appointment if your child is 5 or older and still wets the bed, particularly when it bothers them or your family. Book sooner if there is pain, infections, unusual thirst, daytime wetting, constipation or a sudden change after a dry period. Your GP can refer you to a paediatrician or a local NHS bowel and bladder service.
NICE guidance usually recommends an alarm as the first option for bedwetting when your child and family can manage it, and it can help some older children. The sound or vibration can be difficult when your child has sensory sensitivities, so a continence nurse or paediatrician can help you choose one that suits your child. Progress is usually reviewed after about four weeks, and some families use pull-ups or waterproof bedding while an alarm is being tried.
Share what works at home with your child’s teacher and SENCO: the words you use, your visual schedule, toilet times and sensory triggers. Agree discreet toilet access, extra clothes kept at school and a calm, consistent response to accidents. Review the plan every few weeks so toilet training feels the same in both settings.
Desmopressin, a man-made version of the hormone vasopressin, may be prescribed for some children, particularly when quick or short-term improvement is needed or when an alarm is unsuitable. It comes with professional advice on fluid intake and safety, so it is used under medical guidance. Your GP or paediatrician can explain whether it suits your child.
Dr Lucy Russell is a UK clinical psychologist and Clinical Director of Everlief Child Psychology. She qualified as a clinical psychologist from Oxford University in 2005 and worked in the National Health Service for many years before moving fully into her leadership and writing roles.
In 2019 Lucy launched They Are The Future, a support website for parents of school-aged children. Through TATF Lucy is passionate about giving practical, manageable strategies to parents and children who may otherwise struggle to find the support they need.
Lucy lives with her family, rescue cats and dog, and also fosters cats through a local animal welfare charity. She loves singing in a vocal harmony group and spending time in nature.
