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Individuals with autism spectrum disorders are often plagued with incontinence due to compromised sensory processing between the peripheral and central nervous system. Currently, a combination of the Azrin & Foxx method (1971) and operant conditioning are considered the standard protocol for toilet training children with developmental and intellectual disabilities including individuals with autism. Although programs that have been adapted to children with physical disabilities have resulted in successful toilet train‐ ing in most cases, there is a considerable proportion of individuals with autism who have reached adulthood without being accomplished in bladder and bowel control. These individuals often reside in the spectrum of non-verbal with lower cognition levels (Dalrymple & Ruble, 1992) and exhibit not only incontinence but are challenged with ab‐ normality in toileting such as encopresis, enuresis and fecal smearing. A lack of neuro‐ biological data precluded conclusions regarding the development of, and abnormality in, toilet training individuals with autism. Existing literature is skewed towards treating the aforementioned issue as solely the domain of behavior. Whereas toilet training is both an inherently neurobiological and cultural phenomenon, society’s failure to comprehend and address the problem of some of our most vulnerable members in the autism spectrum re‐ flect a still “Victorian-albeit taboo” in this fundamentally important issue in self-care. This chapter reviews the importance of independent self-care skills in family routines, and proposes a putative sensory-neural understanding of the toilet training-resistant co‐ hort, which is largely unknown. Case studies of two children with autism demonstrate how sensory experiences may affect toilet training success.

The Sensory Experience of Toilet Training and Its Implications for Autism Intervention