In brief
Toilet training is often an important topic for parents. The 2021 guideline stated that it should be completed by the age of five; only after that does one speak of a non-organic elimination disorder, when there are no physical (urological) causes. [3, Ch. C.5.3.3] According to the guideline, bed-wetting, urinary incontinence and soiling are common in children and adolescents with autism. [3, Ch. C.5.3] According to the guideline, assessment and treatment proceed in principle as for people without autism and showed analogous success; physical causes are to be clarified first. [3, Ch. C.5.3.3, Rec. 37] The guideline found no controlled studies on treatment in autism. [3, Ch. C.5.3.2]
This English translation was produced with AI assistance and has not yet been independently reviewed.
Status of the guideline: This article uses the S3 guidelines on autism (diagnosis 2016, therapy 2021). Both have expired. [1] The statements are not automatically wrong, but they are not backed by a valid guideline. The editorial team has not evaluated studies after 2021 here.
What “toilet training” and elimination disorder mean
The guideline distinguished toilet training as part of development (completed by the age of five, according to it) from non-organic elimination disorders: bed-wetting (enuresis), urinary and urge incontinence, rarer forms of incontinence and soiling (encopresis). For the diagnoses, age criteria must be observed in each case. For soiling, treatment must distinguish between forms with and without constipation. [3, Ch. C.5.3] In an overview table on co-occurring conditions in children and adolescents, the diagnosis guideline listed, among others, bed-wetting (11 % in a study of 112 children with autism) and soiling (6.6 %); in a comparison group without autism the values from other studies were lower (soiling 1.1 %); the studies differed in age, sample and definition and are only roughly comparable. [2, Ch. A.3.3, Table 4] That toilet training plays a large role in everyday early intervention was explicitly stated by the therapy guideline. [3, Ch. C.5.3.3] More on early intervention: Early intervention for autism.
First clarify physical causes
The guideline group recommended (consensus-based, strong consensus), where an elimination disorder is suspected, observing the age criteria and clarifying and ruling out organic causes. Only after that should assessment of the non-organic disorder follow according to AWMF guideline 028-026, and then a specific behaviour-based or drug therapy be started. [3, Rec. 37] In practice this means: for persistent problems, the paediatrician (child urology if needed) is the first point of contact. Note: this is a classification by the editorial team in the spirit of the guideline.
Treatment within an overall plan
According to the guideline, therapy of elimination disorders should always take place within an overall treatment plan, because there are often further difficulties, for example oppositional or anxious behaviour, that have to be treated first for work on elimination to succeed. The family and everyday situation must also be taken into account. [3, Rec. 37] For soiling, as long as no valid AWMF guideline existed, the guideline referred to recommendations of the international society for childhood incontinence. [3, Rec. 37]
On medication, it stated: there are indications from case series that risperidone (a medicine used in autism) could trigger urinary and faecal incontinence, in particular in children with intellectual disability, but in a randomised trial elimination disorders were equally common under risperidone and placebo. If an elimination disorder newly occurs under risperidone or another neuroleptic, the medicine should be reduced or stopped and an alternative preparation considered. [3, Ch. C.5.3, Rec. 37] Never stop medication on your own; discuss it with the prescribing doctor. Note: this is a safety note from the editorial team. More: Medication in autism: possibilities and limits.
When further help makes sense
If outpatient treatment remains unsuccessful after about three to six months or the parents have great difficulty implementing the measures at home, part-inpatient therapy, and with additional co-occurring conditions as a rule full inpatient therapy, should be considered in good time (consensus-based, strong consensus). [3, Rec. 38] Relief services for families: Relief for families: services at a glance. On challenging situations at home: Challenging situations at home.
What do we know – what is still open?
Consensus-based/guideline: Physical causes first, treatment within an overall plan, assessment and therapy analogous to children without autism, inpatient options if unsuccessful. [3, Rec. 37, 38]
Open:
- The guideline found no controlled studies on treating elimination disorders specifically in autism. [3, Ch. C.5.3.2]
- How much more common elimination problems are in children with autism can only be read roughly from the small, inconsistent studies of the diagnosis guideline. [2, Ch. A.3.3, Table 4]
- The editorial team has not taken practical instructions for home (steps, aids) from checked sources.
Note: This article offers general information. It does not replace personal advice or treatment by professionals.
Sources and literature
- DGKJP. Aktuelle Leitlinien (Einträge 028-018 „Gültig bis 04.04.2021“ und 028-047 „Gültig bis 23.03.2026“). https://www.dgkjp.de/wissen/aktuelle-leitlinien/ – Professional society (website in German)
- DGKJP/DGPPN et al. Autismus-Spektrum-Störungen im Kindes-, Jugend- und Erwachsenenalter. Teil 1: Diagnostik. S3-Leitlinie, AWMF-Reg.-Nr. 028-018, Stand Text 23.02.2016. – Guideline (in German); expired
- DGKJP, DGPPN et al. Autismus-Spektrum-Störungen im Kindes-, Jugend- und Erwachsenenalter. Teil 2: Therapie. S3-Leitlinie, AWMF-Reg.-Nr. 028-047, Stand Text 02.05.2021. – Guideline (in German); expired on 23 March 2026
You might also be interested in
Knowledge articleParents & family
Family life with a child on the autism spectrum
Knowledge articleParents & family
Challenging situations at home
Knowledge articleParents & family
Promoting parent–child interaction: what parent-mediated programmes showed
Knowledge articleParents & family
My child has been diagnosed with autism – what next?
Found a mistake?
If something is factually wrong, out of date or unclear, let us know. You do not have to give any personal details.