potty training advice

March 24, 2003

Angie,

We had a similar problem when my son was 5. I called Dr. Foxx and he

suggested two things...let the child pick a reinforcer that he would die

for...maybe the ducks/pudding combo has satiated and aren't that powerful

anymore. The other suggestion that worked like a charm was to clean him up

(I used to throw the underwear away and use wipes) then do positive practice

with him...walk him quickly to the potty between 5 and 10 times...stating

firmly, we don't poop in our pants, we poop on the potty. I would stop

trying to catch him in the act or watch for signs....basically, if you go in

your pants, positive practice is the consequence...and be consistent. My

son's situation (which had been going on for 6 months after he was successful

for urine) straightened out in less then a week.

As far as pull ups at night, I wouldn't worry about it. But, I would wait

until the last minute to put the pull up on, limit drinks after dinner, and

remove the pull up as soon as he awakes...this is the best time to pee on the

potty (and could result in poop on the potty too).

Here is an article I wrote about a year ago for our ASA newsletter:

Frequently Asked Questions Regarding Potty Training

By Barbera RN, MSN

I don't consider myself a true potty training expert, but I have successfully

trained my son with autism as well as my typically developing son. I have

also attended several lectures on potty training and spoke with Dr.

Foxx on a few occasions regarding various toileting problems. Many of my

" autism friends " as well as my friends with typically developing children now

come running to me with questions. The following are my answers to some

Frequently Asked Questions regarding toilet training. This information

should not be considered medical advice.

What age should I start?

Consider the child's developmental age. If a child with autism just turned 3

but has a developmental age of 18 months, it is probably too early to start

an official program. However there are some steps you can do prior to potty

training: 1) Keep the child dry and clean by changing his diaper frequently;

2) Comment- " your very wet; " 3) Place the child on a potty in the morning and

at bath time-reward heavily if he is successful; 4) Boys should sit on the

potty for urination until they are fully bowel trained.

My child is 3 and just got diagnosed. Potty training is a priority as I am

expecting our second child next month. Should I start a program?

If a newly diagnosed child is starting a school or home program, you probably

want to gain attention and compliance with easy programs first. You also

want to establish a good positive behavior program (without any negative

reinforcement or consequences) before attempting potty training. This is

obviously a very stressful time for you and your child so I would put it off

for a several months if possible since stressful times are not conducive to

successful potty training. You have to be committed and have good carry

through for a program to work. You need at least 2 solid weeks to be home a

lot and be committed to working almost solely on potty training. Also, I

would look at the 3 months that follow the start date of your program and

avoid planned events like the birth of a sibling.

My child urinates on the potty if I put him on at bath time but never shows

interest throughout the day. How can I motivate him to initiate using the

potty?

A child is usually trained for urination using a schedule before he starts to

initiate. Another key to potty training is determining what will motivate

your child. Choose a reinforcer that your child goes crazy over. " Good

job! " usually isn't enough to motivate any child. If your child loves m & m's,

only give him this special reinforce after a successful trip to the potty.

Another option is to go to the Dollar Store and fill a bag so your child can

pick a toy after each success. I would not recommend using long-term

reinforcers for potty training for any child, especially those with autism

(for example, " I'll buy you a train set when you go pee on the potty for one

week " ). Make sure rewards are immediate, tangible and motivating to your

child.

My child is 5 but I don't think he has the verbal or cognitive ability to be

trained. Are there some cases when potty training is just not feasible?

Azrin and Foxx suggest that by 5 years of age, even severely retarded

children (IQ of about 30) can be successfully toilet trained.

Are there books or videos I should get to prepare myself and/or my child?

Yes, if your child likes videos there are many books and videos on the

subject. My favorite is Once Upon a Potty (for Him or Her). For parents,

Toilet Training in Less than a Day by Foxx and Azrin is a great place to

start and is available for under $7 at amazon.com. Another great resource is

Toilet Training for Children with Severe Handicaps by Dunlap, Koegel and

Koegel available for $3.50 by calling 304-696-2332. Finally, if you are

attempting to train adults or children on the severe end of the spectrum, a

good resource is Toilet Training Persons with Developmental Disabilities: A

Rapid Program for Day and Nighttime Independent Toileting by Foxx.

Our Child has always worn diapers. Should he continue to wear diapers or

pull-ups during training?

No. One of the keys to successful toilet training is for the child to wear

regular underwear during the day. The child needs to feel wet and you need

to spot the accident promptly during the training. During the initial weeks

of training, if you prefer, the child can wear only underwear (no pants) and

a shirt if you are at home. You can get waterproof pants to put over

underwear if needed when you take the child out. Unless the child wakes up

consistently dry, putting a diaper or pull-up on at bedtime is acceptable

both in the short term and in the long term since many children with and

without autism have nighttime accidents. First thing after waking, the child

should be taken to the potty and the diaper removed. Of course, if the child

wakes up dry he should receive lots of reinforcement.

OK, I think I'm ready. What are the components of a formal toilet training

program?

There are five basic steps as outlined in both the Azrin and Foxx book as

well as the one by Dunlap, Koegel, and Koegel. Because of space limitations,

I will only briefly describe each step.

1) Extra Drinks: The child should be given salty foods and extra drinks to

allow more opportunities for toileting during the training period.

2) Scheduled Toileting: This should happen at least 1-2 times/hr. Ask the

child " Do you have to go potty? " Have them say or sign " potty " and take

them. The child should be heavily reinforced if he urinates or has a BM.

Once the child starts initiating, the schedule should be dropped.

3) Dry Pants Checks: There are 2 purposes for this. One is to allow for

detection of accidents. The other is to reward the child for having dry

pants. The child should be asked " Are your pants dry? " These dry pants

checks can be done at intervals of 5 minutes to an hour depending on the

level of success. If you notice an accident, a dry pants check should be

done immediately.

4) Positive Practice for Accidents: Toileting experts such as Dr.

Foxx suggest that Positive Practice is a very important step in the toilet

training process. Positive practice involves taking a child quickly from

the spot of the accident to the toilet and back again 5-10 times. For more

details on this step, read Toilet Training in Less than a Day by Azrin and

Foxx.

5) Data Recording: You will need to record all successful trips to the potty

as well as urine or BM accidents. This will help indicate the length of time

between urination as well as the usual times for BM's. Keeping data will

also help you measure the success of you toileting program.

How long will the toilet training process take?

Some children with severe disabilities train completely in a week, some take

months. If your child regresses and starts having accidents after being

trained, start implementing the steps of the formal program to get him back

on track.

Barbera RN, MSN is the mother of a 6 yo with autism who was diagnosed at

age 3. She is the Founding President of the Autism Society of Berks County

in Pennsylvania. For information about autism, check

autismsocietyofberks.org or contact at mlbarbera@....

September 30, 2006

,

In our experience, the night time training just has come on its own in due

time. We finished day time training (4 - she'll be 5 in June) about

2 months ago, and now just this week she's had a few nights where she's

woken up dry in the morning. I think as they get used to holding it in

during the day, they slowly get used to that at night as well. I wouldn't

put her in underwear at night until she's been staying dry on her own for a

while. There's no need to interrupt her sleep or yours if her body just

isn't ready. This is the same way we handled it with our older two girls as

well - sooner or later we found they were staying dry a few nights at a

time, and then after they stayed dry for 2 weeks or so we just dropped the

pullups and switched them to underwear at night as well. I was encouraged

the other night when I was getting ready for bed that she said, " No

pullup, underwears " . I think we're almost there! If it makes you feel

better, my older girls have had friends who wore pull ups at night (no

special needs - just typical kids) until they were 6. Some kids are just

heavy sleepers and it takes a little more time. I would give K.C. a little

time for now and see what happens. There are night wetting alarms that you

could try down the road, but she may not even need them.

Mom to (8), (6), (4-DS), & Tyler (14 months)

Potty training advice

Hi everyone,

I looking to see if anyone can help me... My daughter, K.C. is going

to be turning 5 in January. We've been working on potty training

her for quite a while now, and she is doing pretty good overall.

She wears regular underwear during the daytime, and will sometimes

go a whole day without having an accident. When she does have an

accident, she will strip off her pants and underwear, so I am

thinking that she doesn't like how it feels. I also notice that she

tends to have a lot of accidents when she is napping or just waking

up from a nap. When I put her down for bed at night, I put her in a

pull up, but I am wondering if I should just go " cold turkey " at

night, and put up with some sleepless nights while she learns that

it's not a comfortable feeling to wet your jammies? My thought is

that if she has an accident while she is sleeping it will wake her

up, and she won't like it, and might learn to hold it until she gets

up (or learns to get up and go potty). Has anyone had any

experiences with this? Oh, and by the way, her accidents in her

underwear are only limited to peeing. She has no problem pooping in

the potty (and I can't remember when the last time that she pooped

in her pull-up!!) Yeah!!. Anyway, if anyone has any advice...I'd

love to hear it. Thank you!!

Mom to K.C. (4 1/2 DS), (3), (3 1/2 months)

October 2, 2006

My oldest son is almost 8 years old and still has occaisional bedwetting at

night. He sleeps like a rock and there's really nothing I can do about it! He

has no special needs either. Rene