Autism Spectrum Disorders Functional Curriculum

Self Help Curriculum Checklist: Restroom Skills

Student Name:______________________________ Instructional Period: ______-_______
State Standards: Wellness: Health Promotion Concepts
Skill Domain 4: Toileting
Skill Area: Identifies Toileting Vocabulary and Concepts
Co-Curricular Areas Skill: Baseline: Initiated: Mastery:
Reading &
Identifies bathroom items/pictures (e.g., toilet, sink, mirror, etc.)
Language Skills
Identifies and demonstrates comprehension of bathroom words &
Reading
phrases (e.g., go to the bathroom, wash hands, toilet, sink, etc.)
Spelling Spells bathroom words (e.g., bathroom, toilet, sink, etc.)
Skill Area: Uses Bathroom When Needed Without Having Accidents
Co-Curricular Areas Skill: Baseline: Initiated: Mastery:
Independence Skills Remains dry during the day
Independence Skills Remains dry at night
Independence Skills Uses toilet on schedule
Independence Skills Initiates toilet use
Communication &
Initiates bathroom requests when restroom is needed
Language Skills
Communication & Initiates bathroom request before leaving school building for an
Language Skills outing
Accepts Delays &
Independence Skills
Waits for up to 10 minutes after requesting the bathroom
Accepts Delays &
Independence Skills
Waits for up to 2 hours between restroom trips
Skill Area: General Restroom Skills & Restroom Safety Skills
Co-Curricular
Areas
Skill: Baseline: Initiated: Mastery:
Personal Safety Identifies individuals who can/cannot provide assistance in the
& Social Skills restroom
Personal Safety Accepts assistance from “safe” or designated individuals in the
& Social Skills restroom
Personal Safety
Refuses assistance from non-designated individuals in the restroom
& Social Skills
Personal Safety
Refrains from social conversations in the restroom
& Social Skills
Reading
Identifies and discriminates between community restroom signs
& Social Skills
Reading
Uses appropriate restroom for own gender
& Social Skills
Discrimination
Determines if restroom is available (single stall restroom)
& Social Skills
Discrimination
Determines if urinal or stall is available (multi-stall restroom)
& Social Skills
Tolerates Delays Waits in appropriate location for restroom, stall or urinal to
& Social Skills become available
Personal Safety Enters restroom, closes and locks door before undressing
& Social Skills (Stall or single person restroom only)
Personal Safety Remains inside own stall during use
& Social Skills (Without climbing over/under or looking into other stalls)
Responds appropriately when someone knocks on stall or restroom
Personal Safety
& Social Skills door (e.g., States “I’m busy,” “Someone is in here,” or indicates timeline “Almost
finished.”)
Personal Safety Responds appropriately when a familiar person asks status
& Social Skills (e.g., “Are you almost finished?”)
Hygiene Wipes toilet seat with toilet paper before sitting down

Created by Kristine Noonan of Autism, The Teen Years

Self Help: Restroom Skills Page 1 of 2
 Autism Spectrum Disorders Functional Curriculum

Hygiene Uses seat liner or lines toilet bowl with toilet paper before sitting
down
Adjusts clothing to use toilet (Unfastens and lowers pants and underwear
Hygiene
to sit on toilet, moves shirt out of way of front/back of toilet seat as necessary)
Hygiene Sits on toilet for bowel movement
Wipes thoroughly after bowel movement
Hygiene
(e.g., Wipes 3 times, retrieves new toilet paper, wipes and checks for cleanliness)
Hygiene Keeps hands out of urinal/toilet bowl when in use
Social Skills Flushes toilet/urinal after use
Redresses immediately after toilet use
Personal Safety
(Prior to exiting stall or leaving urinal/toilet area)
Adjusts clothing after toilet use (Raises and fastens undergarments and
Personal Safety
pants, adjusts shirt and pants to straighten)
Exits restroom/unlocks stall door (after redressing) upon request
Personal Safety
from a familiar person (e.g., “Please open the door.”)
Personal Safety
Exits stall/urinal area and immediately after use
& Social Skills
Hygiene Washes and dries hands immediately following toilet use
Hygiene, Grooming Checks appearance and straightens clothing in mirror after toilet
& Social Skills use
Personal Safety Exits restroom immediately after completing entire restroom
& Social Skills routine
Personal Safety Waits in hallway/outside of restroom or in other designated area
& Social Skills for a caregiver to exit the restroom
Skill Area: Male Restroom Skills
Co-Curricular
Areas
Skill: Baseline: Initiated: Mastery:
Personal Safety
Selects urinal which provides most privacy if others are in use
& Social Skills
Personal Safety Remains oriented towards wall without looking to sides when using
& Social Skills urinal
Refrains from touching items inside urinal
Hygiene
(e.g., urinal freshener, ice, etc.)
Personal Safety
Lowers pants and undergarments in front only when using urinal
& Social Skills
Personal Safety
Raises/lowers toilet seat before/after urinating
& Social Skills
Hygiene
Aims into toilet when urinating
& Independence
Hygiene
Aims into urinal when urinating
& Independence
Skill Area: Female Restroom Skills
Co-Curricular
Areas
Skill: Baseline: Initiated: Mastery:
Hygiene &
Wipes thoroughly after urinating (female students only)
Independence
Hygiene &
Places panty liner/sanitary pad into underwear
Independence
Hygiene &
Keeps panty liner/sanitary pad in underwear between restroom uses
Independence
Hygiene & Monitors need to replace panty liner/sanitary pad with visual
Independence supports (e.g., rule card, timer, schedule, etc.)
Hygiene &
Disposes of panty liner/sanitary pad appropriately
Independence

Created by Kristine Noonan of Autism, The Teen Years

Self Help: Restroom Skills Page 2 of 2