Firstly let me apologies for the delay in getting back to you we have had an overwhelming response to the “ask the expert” feature and I have been busy getting through the list of questions. You’ve already done many of the things I would have suggested. Given his developmental delay I actually would not expect him to be toilet trained at this early age – you will find that many boys without a developmental delay are yet to achieve daytime bladder and bowel control at age 3. Behavioural reinforcement is typically your best option in encouraging the use of a potty or toilet – however I would recommend rather than using a star chart have your son choose what incentives he would like. When I use behavioural training programs with autistic children I typically modify the incentives so that they take into account the likes and dislikes of the child. With one boy I used anything to do with Thomas the Tank Engine – with another it was lollies (not great for the teeth but it worked a treat!), another child I worked with loved books – so every time he collected 5 stickers he was allowed to cash these in and buy a small book. Many children find the toilet frightening so I would stick with a potty for the time being – perhaps you could get him to help you find a place for it to sit (obviously this will need to be mutually agreeable). Check with him that he likes the potty you have chosen otherwise take him shopping and get him to help you pick out a new one – the key thing with children with Autism or Aspergers syndrome is that they need to feel comfortable with their surroundings. I would begin again by encouraging him to sit on the potty when he is fully clothed so he doesn’t associate it with negative feelings. He could do this while watching a favourite program on TV or while reading a book. It is not unusual for children to withhold urine or poo when they feel pressured to toilet train. I understand your feelings of urgency however if he is not showing signs that he is not ready to be trained then the best thing to do is to just stop for a few weeks – this will take the pressure off both you and your son. You can use this time to talk about using the potty – letting him watch you and your husband using the toilet as much as possible – make sure the potty is visible if he decides to use it on his own that’s great but avoid putting him on it unless he indicates he wants to. When it is time to start again introduce everything slowly taking your cues from his behaviour. Encourage him to sit for wees and poos – otherwise you may find it difficult to get him to do poos in the potty if he does wees standing up. A ‘slowly slowly’ approach will be the key to success – if he feels forced he is likely to revert back to old habits. Good luck – please do not hesitate to contact me again if this doesn’t work.

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