How Can I Help My Autistic Child Switch from Diapers to Underwear?

Supporting Sensory Needs and Overcoming Resistance

Table of Contents

• Why Is My Autistic Child Resisting Underwear?

• Start with a Social Story

• Try the Gradual Cut-Out Method

• Experiment with Underwear Styles, Sizes, and Textures

• Add It to Their Visual Schedule

• Use a First-Then Visual

• Use a Reward Chart to Motivate Progress

• Tap Into Special Interests

• Other Tips That Can Help

• Related Resources

Why Is My Autistic Child Resisting Underwear?

For many children with autism, underwear isn’t just a new item of clothing—it’s a disruption to their routine and an addition of a sensory sensation to get used to wearing.

Pull-ups often feel soft, secure, and familiar, while underwear can be tighter or loser, feel slippery, or just feel novel.

Add in sensory sensitivities, anxiety about accidents, and a strong preference for sameness, and it's easy to see why some children refuse to make the switch.

Start with a Social Story

One of the easiest ways to introduce this change is with a social story. These short, structured narratives can help your child understand what underwear is, why people wear it, and what will happen during the transition.

You can purchase this underwear transition social story, or create your own.

If making one yourself, consider phrases like:

• “Underwear goes under my clothes.”

• “I can try wearing underwear for a little while.”

• “It’s okay to practice. It doesn’t have to be perfect.”

• “Grown-ups can help me try new things.”

Add photos or simple drawings. Read the story daily for a week or two before starting the switch.

Try the Gradual Cut-Out Method

If your child absolutely refuses underwear, consider a step-by-step desensitization approach. This approach is sometimes successful for autistic children who insist that a diaper or pull up be put on them before they will have a bowel movement in the toilet.

This method can ease the sensory shift:

1. Have your child wear a pull-up while sitting on the toilet.

2. Begin cutting a small hole in the bottom.

3. Gradually increase the hole over days or weeks, until the pull-up no longer offers full coverage.

   
   

This method helps the child slowly adjust without sudden changes. For many, this incremental exposure reduces anxiety and resistance.

Experiment with Underwear Styles, Sizes, and Textures

Not all underwear feels the same. Some children may tolerate certain types better than others:

• Tagless or seamless styles

• Loose-fitting boxers instead of snug briefs even if it is a little girl

• Bikini-style or high-waisted

• Breathable cotton, bamboo, or athletic material

• Sizes, experiment with a size bigger or smaller to see if child likes the feeling of something tight or likes the feel of something looser.

  
  

Let your child feel the fabric before trying it on and if possible take your child to the store and let them feel the fabric of a variety of underwear. Some kids will show a preference but would not have been able to verbalize this to you.

Add It to Their Visual Schedule

If your child already uses a visual schedule to understand daily routines, adding a visual for “underwear” or “get dressed” can be a simple but powerful way to reinforce the new expectation.

Children on the autism spectrum often benefit from seeing what comes next, especially when routines are changing. A visual schedule can help reduce anxiety and make the idea of wearing underwear feel like just another part of the day.

You might place the underwear icon:

• After “use the toilet”

• Before “put on clothes”

• Paired with a photo of the child’s actual underwear for extra familiarity

If you don’t have a visual schedule yet, this could be a great time to start with a simple morning routine chart.

✅ Use a First-Then Visual

For children who need something more simple, a first-then board can be incredibly helpful during the transition.

• First: Wear underwear

• Then: Watch a favorite show, get a sticker, play outside, etc.

This approach can reduce resistance by showing your child that something they enjoy will follow the challenging step. It's especially effective if the reward is something immediate and motivating.

Use a Reward Chart to Motivate Progress

Click here to grab your free "I Wear Underwear! Chart

For many autistic children, visual progress charts can make abstract goals feel more concrete and achievable. A sticker chart designed like a board game can turn the process of wearing underwear into something fun and rewarding.

Every time your child wears underwear—even for a short time—they earn a sticker. As they follow the path, they can see their progress and feel a sense of accomplishment. If the sticker lands on a picture of underwear, that’s a bonus space—and they earn a small treat!

You can download my free underwear-themed sticker chart here to get started. It’s:

• Editable, so you can customize how often your child earns a reward

• Visually engaging, using a simple gameboard format

• Naturally designed to fade reinforcement, with prize spaces gradually spaced farther apart as the child progresses

  
  

Low-cost reward ideas include:

• A trip to the playground

• A visit with a favorite neighbor or family member

• A small lollipop or piece of candy

• Picking the next story or show

• Time with a favorite toy or sensory bin

Even small rewards can make a big difference in motivation when paired with visual reinforcement and encouragement.

Tap Into Special Interests

Special interests can be powerful motivators. Look for underwear that features your child’s favorite animals, characters, or themes (like space, ocean, or trucks).

If you can't find the exact design your child loves, make it! I once had a child who was obsessed with a specific type of ocean creature, and we couldn’t find it on any underwear. So we bought plain briefs and put a sticker of the creature on them together.

🧼 Tip: Be sure to remove any stickers before laundering the underwear!

You could also use fabric markers or iron-on patches for a longer-lasting solution.

Other Tips That Can Help

Here are a few more ideas to support your child’s success:

✅ Use underwear as part of a visual schedule – Show the steps: "Wake up → Use bathroom → Put on underwear."

✅ Let them practice at home only at first—just during a favorite TV show or while playing inside.

✅ Celebrate small wins – even sitting on the toilet while wearing underwear counts!✅ Provide positive sensory input before asking child to try on underwear or right after they put it on, such as jumping or swinging

✅ Avoid pressure – forcing the change can backfire. Instead, aim for calm and consistent encouragement.

Final Thoughts: Go at Their Pace

Toilet training is already a big hurdle. Adding the switch to underwear can feel like another mountain—especially for autistic children dealing with sensory sensitivities or communication delays.

But progress is possible. With the right tools—a good social story, gradual exposure, respect for sensory needs, and plenty of patience—you’ll help your child gain the confidence and comfort to wear underwear on their own timeline.

🌈 Related Resources

• Social Story: Transitioning to Underwear

• Potty Training Visual Supports

• Free Potty Training Social Story

• Free Wear Underwear Sticker Chart