Part 2 Potty training a child with autism

In Part 1 of “potty training”, we had touched upon the three readiness test and sensory issues related to toileting. Now we further our discussion on “Toilet training” in this article. Lot of children pass stools in their diaper outside the toilet in standing. The sensory challenge contributing to this behaviour could be one or all of the following:
  1. Fear of squatting,
  2. Dislike for entering a wet toilet,
  3. Fear of sitting on a pot with feet dangling,
  4. Fear of the sound of flush
  5. Sense of discomfort with sudden empty feeling etc.
How can one deal with these challenges? Maybe,
  • Placing a stool under the child’s feet while putting him on the potty
  • Letting the child wear slippers while entering the toilet
  • Not flushing while the child is in the toilet
  • Making the child sit on the pot with a loosely fitted diaper and then replacing the diaper with a panty could be some of the ways to address these challenges.
Parents often struggle with teaching their child how to wash, clean and dress up. Children, with touch sensitivity, dislike cleaning or dirtying their hands. Sensory integrative dysfunctions impact ability to plan an action like learning to wash which is a very complex two hand activity. What can we do? Parent need to teach the skill by using hand-on hand strategy. The skill needs to be broken down into small steps like the mom will pour water with one hand and with the other hand she holds the child’s hand and guides him to move it from back to front and clean himself. Letting the child sit on the potty seat to dress up, using a water jet instead of focusing on this complex skill are a few adaptations parents can use especially when they observe that the child is taking very long to learn the skill.
 
PART 2: Potty training as Behaviour Like any other skill, learning to become independent in toileting, too has a behavioural aspect associated with it. Following the behaviour modification principles
  • Work on introducing
  • Mastering
  • Generalizing the skill is the key to success.
For example for training to build bladder control, schedule training is very effective.
 
Introduction
 
Start taking the child every 90 minutes- goal is to teach the child to void when placed on the seat. On an occasion when he does not void turn the next interval to 60 minutes and then again go back to 90 minutes. Taking the child at a shorter duration will reduce chances of accidents but will not help the child to build the control and will not help the child to learn to control till taken to toilet. Once he gains control over bladder and bowel, he will learn to go independently. Not buying a baby potty seat and using a toilet ring for the adult toilet seat avoids challenges associated with transition to the toilet seat. Do not make a mistake of taking the child to toilet only when he appears to show the need to go because this will promote dependence on you. Consistency and regularity is the key to success. Randomly taking the child will increase chances of accidents. While following the schedule, take him to the toilet and at every 3 rd minutes reinforce him for good sitting. Remember to not shock the child by profuse cheering- keep a special toilet related reinforce. He would be returned to the seat in 90 minutes but he does not void in 15 minutes, allow him to get up but then return him in 60 minutes. Do not get disheartened if an accident happens but engage him in cleaning without making it punitive and stay emotionally neutral. Once you start with training, do not put the child on a diaper during the day- but only during nap and at night. Once 90 minutes schedule is in place, you can increase the time by 15 minutes.
 
Mastering independent toileting Once the schedule is in place-besides lengthening the schedule, place the child on the chair next to the toilet seat without his clothes- reinforce him every 3 minutes, do not prompt him to go to toilet seat but reinforce when he goes by himself. If accident happens- do not prompt, let him complete the accident on the chair – but go back to previous step of putting him on toilet chair rather than the other chair. Once the child shows consistent success- increase the distance between the chair and the toilet and add one piece of garment so the child learn to disrobe and go towards the toilet. The next step would be ‘Dry pants check’. Here you will no longer  take the child to toilet and provide reinforcement for staying dry, asking him to check if he is dry every 15 minutes, if there is accident, follow the correction procedure and later, slowly increase the check time to 30 minutes.
 
Generalizing the learnt skill If you and your child have reached till here then comes the stage of teaching him to generalize the skill i.e. making him independent in performing all the steps from start to finish without any prompts in different settings without a single accident. Some rules to remember-“Don’t help! Don’t remind!” Many children with developmental disabilities readily return to relying on adults for help, because this has proved in the past to be the most reliable way of achieving a result.
 
 Make sure that your child has free access to a toilet whenever possible.
 
 In new places, always show your child where the toilet is.
 
 If your child is constantly distracted and uncertain about what to do, it is worth continuing the use of reward, but intermittently (randomly with no predictable pattern), rather than at every successful toileting. Create opportunities for the child to practice his learnt skill in different situations like the mall; friend’s house etc. which also means that he should be able to do it in a ‘socially appropriate manner. For example, the child should be able to use men’s toilet and urinal, without fully undressing lower garments. The biggest adult created hurdle in this is that till the child is 5 or 6, female caregiver is likely to take him in the toilets with her which looks and even smells different from the men’s toilet. The child, as grows older, is then expected to use Men’s room independently.
 
It is important to remember that the child cannot learn this transition over-night. Using social stories, visuals are some of the other effective modalities which can be used while teaching potty training. Dear parents, remember potty training is one of the skills you would like the child to learn. Every child and a child with autism being no exception, he/she can sense what behaviour gets caregiver’s attention and some things, which may start as sensory, could turn into behaviours in your child. As a parent, one needs to remember to not make potty training a ‘battle of will’ because that will make it harder for you and for your child. Once again leave a comment below, letting us know about your experiences.
 
Thank you
 
References:
  1. Building bridges through sensory integration by Ellen Yack, Shirley Sutton, Paula Aquilla
  2. A Work in Progress: Behavior Management Strategies & A Curriculum for Intensive Behavioral Treatment of Autism by Ron Leaf, John McEachin, Jaisom D. Harsh
  3. Potty training for children with autism or intellectual disabilities. Developmental Information and Practical Procedures by Sue Bettison
Posted in Default Category on August 13 at 06:17 PM

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