Potty training..special needs edition

[Deleted]

Advice? Tips? Im struggling with determining readiness here.

My ds1 is 3.5 and has epilepsy as well as dyspraxia/apraxia of speech, Communication is still very much a struggle. He has plenty of single words, but still struggles with putting words together, and many of his words all sound the same or similar, so we also struggle to understand what hes saying a lot.

As far as potty training goes, we havent pushed it too much, since he hasnt shown a strong outward interest. Hes shown some slight interest in the past, so we'd start slow with just asking and sitting him on the potty. Hes peed on it a couple times here or there, but hasnt again in months. He can usually tell us after the fact that he peed or pooped in his diaper, but does not tell us beforehand. We've also tried prompting him to sit on the potty, but now hes taken to straight up refusing. If he does oblige to sitting on the potty (which is usually bc he sees our 18mo sitting on it- who is just starting to show a slight interest), he will just sit and fiddle with himself, which he finds hilarious...but wont actually pee or poop. He'll usually pee right after in his diaper (or in the tub at bathtime).

As of recently, hes taken a real fascination with his penis, so hes starting to dig around in his diaper or just pull the diaper off if hes not wearing pants, which has resulted in quite a few poop messes from him digging around in there. So i guess my question is this..should i be trying to push using potty because of this? Or just deal with it until hes showing more of an interest? At this point, i think I'm more ready for him to potty train than he is. Simple redirection doesnt work, so i feel like my options are either push to potty train or damn near duct tape his diaper on.

[numbbears]

Our kids are close in age and DS also has a speech delay. He more often just goes in the bathroom and sometimes says "o ee otty" when he needs to go. We're still working on potty training, but he's gotten really good since we started and has some days where he never even wets the pull-up (just pee, not poo). HE also went through a phase where he just wanted to play with his penis and constantly ended up with poo on his hands before we had a chance to change him. I think it was just a phase as he was getting use to the potty.

This is some of the stuff that worked for us:
-When I go to the bathroom, he wants to imitate me. So I bring him with me every time.
-Pull-ups instead of a regular diaper. It's easier for him to stick his hands in and we struggled with the transition, but once he adjusted, he did well.
-When he would potty in the tub, I'd hold his potty chair in front of him. He potties beforehand in the chair now.
-We originally had him sitting on the toilet with the potty training seat on it, but he started disliking it a lot so we switched to the potty chair and it clicked with him.
-And the biggest thing has been the reward system. It started with getting to stamp on a poster, then an m&m, and now I let him pick out his treat. If he pees in his diaper, I remind him that he only gets a treat if he uses the potty.

[Deleted]

Aug 31, 2016 21:38:00 GMT -5 lfigge said:

Would he do well with a treat for going? I've heard a lot of people have success using an m&m as a reward for going on the potty.

Im going to follow this for suggestions. We are slowly venturing into this territory. S will sit on the potty, but has yet to actually go on the potty. She also hits/grabs at her diaper and says "poo poo" a lot. But she does it when she's wet or dry or poopy, so not narrowing it down yet.

We are in-patient right now for an overnight EEG and she kept saying poo poo. So I took her and set her on the potty and all she wanted to do was try to stick her hand in the toilet. So I don't know how close we really are.

Not sure how he'd do with a treat as incentive. Its worth a shot, though i think the main problem is that hes just not at all motivated to use the potty. I ask him if he'd like to try to "use the potty like a big boy", and i mention how the other kids at school are using the potty, and wouldnt it be cool, and blah blah blah..but no dice. He just doesnt seem to have any interest.

When he does sit on the potty all he does is laugh, bounce around, and play with his penis, which is just about all my 18mo does as well..so im guessing i should just give it up for bit. But UGH. Im so ready for them to potty train.

[Deleted]

numbbears thanks for the suggestions. Maybe we'll try pull ups for the time being. At the very least we wont need to worry about him.ripping his diaper off, and maybe it'll motivate him a little. Idk. We've used pull ups here and there before, and they seem to make no difference to him.

[numbbears]

Same thing here. We went back and forth for a little while, but one day he randomly started pointing to the pull-ups again and it's clicked with him ever since.

[Deleted]

Sept 1, 2016 17:05:26 GMT -5 numbbears said:

Same thing here. We went back and forth for a little while, but one day he randomly started pointing to the pull-ups again and it's clicked with him ever since.

Thats wonderful! Im hoping thats the case with us soon.

[KC thepouchh8r]

I'm assuming with apraxia receptive language is on track, no? Could using the fact his peers go to the bathroom on a potty be a helpful incentive and/or using a toy he really wants to earn through x amount of pee/poop on potty?

Either way this app is helpful. It creates an avatar of your kid which you create to look like them/has their name if he identifies his name in print. It goes through the process of going potty.

www.avakid.com

We used this paired with telling her diapers were done, we were so proud she was a big girl now. We did timed trips initially, pushing lots of fluids/Popsicles 30 minutes prior so her bladder would be full and we would be setting her up for success. We let her watch her iPad while she sat to keep her distracted and made a big deal when she went. We did no underwear/pants so we could easily tell when she was starting to have an accident. When she began going we ran over, said "no, pee/poop goes in potty" and directed her there. After she sat on the potty we had her assist in cleaning up the accident. It was messy and required lots of wine but it worked.

[mrsbuttinski]

Some random thoughts on this-

1. IME, parents who "dabble" at PT aren't generally successful unless they have a unicorn child who trains themselves. These children tend to either have sensory aversions, are well developing and want to be like older kids or want something associated with being clean and dry. A 3 Day method might be a better option.

2. There are a lot of things one teaches a child in which that child has zero interest- toileting, driving, laundry, algebra- all come to mind. These are life skills that will impact quality of life going forward and need to be taught without regard to the child's interest.

3. At 3 1/2, unless there is some profound ID or physical challenge, the child should be physiologically ready to learn to use the toilet. Does he have physical readiness behaviors?

4. Receptive language would be helpful, but I'm not sure how expressive language impacts toileting. Early on, you take them on something of a schedule with a goal that they go independently without your involvement at some point. If you feel the need to communicate around "do you need to go" a PECS board or laminated cards could be used. I know a few deaf kids who weren't verbal or signing who were trained as well as a whole bunch of non-verbal kids with ASD who were.

5. He's at an age where you might want to start working on the concept of masterbation, aka "playing with his penis", as a private activity restricted to, say, his bedroom or bathroom. This is very "normal" for the age, btw, and not something about which you want him to feel badly- but you want to help him learn the social expectation that it's private. This can be a very off-putting behavior for some people (teachers and kids primarily) and can signal greater impairment than exists which means lowered expectations.

[weeklyplanner]

DS only just turned 2, but I've wondered how PT would go if he can't tell me he needs to go due to his apraxia. Then I remembered that in my old classroom (I was a K/1 self contained/multiple handicap teacher), we taught all the kids the sign for bathroom. Even those who could say the word would say and sign at the same time to ensure an adult in the room saw their request. You may want to use the sign in addition to verbal and teach everyone he has contact with the sign? This could be helpful....or not, ha. My only other experience with PT is setting a timer for 30 min and leaving it at a child's desk and then taking them into the bathroom. I realize this is more the "train the teacher/parent" route, but for some kids they would be so excited that they went potty that it did eventually click. Other methods may be better though....

[Deleted]

KC thepouchh8r Yes, his receptive language is basically on track for his age. I will check out that app! We have tried using his peers as a motivator..it doesn'tseem to phase him though. He will straightup tell me "no!!" when i tell him its time to use the potty. He seems to be very averseto it, which i have no clue why. So we haven't been pushing it. Our dr keeps telling us to not push and make it a battle of wills.

mrsbuttinski Thus far, we have been telling him that touching his penis is something to be kept in private. Either bathroom or bedroom. Like you mentioned, my thought process is that i do not want him to feel badly about it. So i try not to outwardly tell him no...its more about redirecting it to a "private activity". The issue is that he either just doesnt understand that, or doesnt care. Most times, when we tell him "touching your penis is something you do in the bathroom or bedroom", he just laughs and continues to do it, thinking its hilarious. Although, redirecting energy to a completely different activity will work most of the time, so thats what we've been doing. When we can actually get him on the potty, its like hes not able to sit still long enough to stay focused, which at 3.5 is probably pretty common, i assume. He would rather bounce around, laugh, and play with himself. When i say "pee and poop go in the potty" he laughs and says "no, tub!" He finds it pretty funny to pee in the tub. So maybe its a control thing?

[mrsbuttinski]

Sept 4, 2016 9:04:38 GMT -5 @mrst0514 said:

mrsbuttinski Thus far, we have been telling him that touching his penis is something to be kept in private. Either bathroom or bedroom. Like you mentioned, my thought process is that i do not want him to feel badly about it. So i try not to outwardly tell him no...its more about redirecting it to a "private activity". The issue is that he either just doesnt understand that, or doesnt care. Most times, when we tell him "touching your penis is something you do in the bathroom or bedroom", he just laughs and continues to do it, thinking its hilarious. Although, redirecting energy to a completely different activity will work most of the time, so thats what we've been doing. 


Great. Sometimes wordlessly leading them to that space can work as well. Once it clicks, you can prompt verbally.


When we can actually get him on the potty, its like hes not able to sit still long enough to stay focused, which at 3.5 is probably pretty common, i assume. He would rather bounce around, laugh, and play with himself. When i say "pee and poop go in the potty" he laughs and says "no, tub!" He finds it pretty funny to pee in the tub. So maybe its a control thing?


That's not really that common. Toileting is a zero order skill by age four- i.e. almost all kids will be well on the way to mastery- either very independent in terms of recognizing when and managing the process, following prompts or a schedule, needing help with the paperwork at most. 

I wonder if a more draconian approach will be needed in order to make him care. It was at my house. I had the luxury of PTing a kid w/o a dx. My MIL was dying when DS was that age and we were making constant drives to my BIL's house 700 miles away so I it off until DS was almost 3 1/2. He was physically ready- waking dry, seeking seclusion to stool, able to dress and undress. So I put him in Thomas undies and instructed him to keep Thomas dry while plying him with juice and ginger ale. He wet himself 2 or 3 times and was dry by noon. Bowel training took a bit longer and only clicked when we gave him ownership of the clean up process- two stints at clean-up that took care of that, too. 

DS found peeing something of a fun activity. He loved peeing in the old coffee can my dad kept on his boat, loved to pee in bushes, and even the cats' litter. I think it's a man thing. If you are teaching "pee goes in the toilet", it might make sense to end the bath as soon as he pees- it's a natural consequence he should be able to learn from. 

[Deleted]

mrsbuttinski thanks for your suggestions. I do agree with you in that a different, more structured approach may be needed here, in order to make him care and more motivated to use the toilet. I've talked to mh about maybe trying the 3 day method over a weekend. I think we really just need to make a plan and stick to it with consistency. No more half assing, or else ds isnt going to take it seriously.

As far as physical readiness, he wakes up dry from naps, but usually wakes wet first thing in the morning. He will insist on finding a quiet corner or "hiding" to poop in his diaper, but not all the time..maybe about 60% of the time? I feel like hes mostly ready, but tbh, hes met us thus far with so much resistance that we sort of just gave up temporarily. As the pedi tells us, its not worth making it a fight, but at the same time, im ready to just do it and be done with it. So im hoping i can find his currency with this and just do it, but I dont want it to be a battle of wills either.

[mrsbuttinski]

He sounds physically/emotionally ready. Overnight dryness is typically 2 years beyond daytime, so waking wet is within the range of "normal" at this age. A 3-Day with him participating in the consequence of "accidents" might work. My kid had no f*cks to give about being trained; he's lazy and found diapers convenient- I had to take them away to gain compliance.

I wonder if your ped's advice would be different absent the dyspraxia and epilepsy. A 3, DS just seemed really smart; his pedi had no problems giving him ownership of the process and work associated with screwing up.