Sensory Processing Disorder and Potty Training

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The SPD Companion, Issue #016-- SPD And Potty Training

July 06, 2007

Hello,

Welcome to the July 2007 edition of The SPD Companion Newsletter.

Today's topic? SPD and Potty Training.

For so many, this combination goes together as well as oil and water.

I want you to know the difficulties you are experiencing, have

experienced, or will experience with this major developmental task

are NOT your " fault " nor your child's. In order to truly understand

why I say this, we must take a good hard look at the way SPD affects

a " new sense " you may be less familiar with.

We all know the typical 5 senses; vision, hearing, smell, touch

(tactile), and taste. If you are familiar with Sensory Processing

Disorders, you most likely know about, and hopefully understand, two

more important senses; the vestibular and proprioceptive senses.

Now, we will add one more sense to these previous 7... the

interoceptive sense. It is a well known sense to those who research

and study neurobiology. But, it is far less talked about than the

other senses. It is time to start talking about and understanding it

IF we are to truly understand the inner struggles our SPD children

must contend with. We also must understand this sense so we know why

they do what they do and how we can help them.

Traditional methods for potty training will not work with these kids,

as many of you may have already found out!

The Interoceptive Sense:

The interoceptive sense refers to the " body-centered sensory

systems " , the " near senses " , which operate without conscious thought

and cannot be observed. The interoceptive sense relates to

the " sensory nerve cells innervating the viscera (thoracic,

abdominal, pelvic organs, and cardiovascular system), their sensory

end organs, or the information they convey to the spinal cord and the

brain. "

(from www.answers.com medical dictionary, 2007)

Therefore, the interoceptive sense includes input regarding the

following:

heart rate

thirst

hunger

digestion

state of arousal

mood

temperature

respiration

bowel and bladder

Considering all the innervations of the internal visceral organs via

the interoceptive sense, is it ANY surprise our SPD kiddos (and

adults) may have difficulty in more areas than we even thought (or

knew, but didn't know WHY)? Can you also now see how many of these

kids are easily MISDIAGNOSED? If we isolate each of these and we see

problems in these areas, is it no wonder our kids are diagnosed with

other physical and mental health diagnoses?

Dr. Lucy , in her book " Sensational Kids " , breaks Sensory

Processing Disorder into three main subtypes:

1. " Sensory Modulation Disorder (SMD) is a problem with turning

sensory messages into controlled behaviors that match the nature and

intensity of the sensory information. " This would include sensory

over-responsivity, sensory under-responsivity, and sensory

seeking/craving behaviors.

2. " Sensory-Based Motor Disorder (SBMD) is a problem with stabilizing,

moving, or planning a series of movements in response to sensory

demands. " This would include dyspraxia and postural disorders.

3. " Sensory Discrimination Disorder (SDD) is a problem sensing

similarities and differences between sensations. " This would include

vision, hearing, touch, taste, smell, position, and movement. (Lucy

, 2006)

Thinking about each of the above mentioned carefully, we can then

understand how each of these subtypes, when disordered/inefficient,

could lead to difficulties in the interoceptive sense. These may

include:

becoming too hot or too cold, sooner than others in the same

environments

difficulty in extreme temperatures or going from one extreme to

another (i.e., winter, summer, going from air conditioning to outside

heat, a heated house to the cold outside)

respiration that is too fast, too slow, or cannot switch from one to

the other easily as the body demands an appropriate response

heart rate that speeds up or slows down too fast or too slow based on

the demands imposed on it

respiration and heart rate that takes longer than what is expected to

slow down during or after exertion or fear

severe/several mood swings throughout the day

unpredictable state of arousal or inability to control arousal level

(hyper to lethargic, angry to happy in short periods of time, perhaps

without visible cause)

frequent constipation or diarrhea, or mixed during the same day or

over a few days

difficulty with potty training; does not seem to know when he/she has

to go (i.e., cannot feel the necessary sensation that the bowel or

bladder are full

unable to regulate thirst; always thirsty, never thirsty, or

oscillates back and forth

unable to regulate hunger; eats all the time, won't eat at all,

unable to feel full/hungry (prone to eating disorders and/or failure

to thrive)

Please make sure, if you are noticing these signs in your child, you

take a look at the Sensory Processing Disorder Symptom Checklist

and/or The SPD Symptom Checklist For Infants/Toddlers to see if your

child shows further signs of SPD that may indeed warrant an

evaluation. If you need help finding an Occupational Therapist, go to

the first edition of my newsletter (you can find it on my site map ,

or the back issues link on my newsletter page).

Do you SEE how SPD can affect a child's success with potty training?

Given all the sensory information that must be processed efficiently

and effectively? Does this make sense? Let's explore specifics about

potty training even further.

For most parents, the idea of potty training initiates from several

factors. The first... a child's age. We know that between 18 and 36

months " typical " children are developmentally ready to begin this

important milestone. This is usually the first reason we start the

process. However, as I will explain, this can easily be our

first " mistake " in trying to potty train children with SPD or other

special needs. A child's chronological age is FAR less important than

their " developmental age " or physiological readiness. And it is THIS

that we must first understand and take into consideration BEFORE we

begin potty training " demands " on our SPD (or special needs) child. A

child may be delayed in other areas so we must accept they may be

delayed here too.

The second factor that may spark a decision to begin potty training

is the cost and inconvenience of diapers. We become anxious about

wanting to get rid of this added hassle and expense. We then also

assume that as long as they continue wearing a diaper it is

too " easy " for the child to keep using this approach for eliminating.

Sometimes, we decide to buy Pull-Ups, training pants, or underwear in

hopes of training them by way of accidents. This is NOT a good method

of potty training SPD kids... it can do more psychological harm than

good if they are not developmentally or physiologically ready to

potty train.

A third factor that may enter into our decision to start potty

training our SPD kids is " peer pressure " on YOU, as a parent. Who is

nagging you to get your child potty trained, no matter what the

emotional cost to your child? Is it your mother, the in-laws, your

friends, the day care, other family members, or your pediatrician? Do

they understand SPD? Do they know the real reasons your child may not

be ready yet? Do YOU? Do you feel the guilt or " failure " as a parent

if your child is not potty trained at the same time as his peers? Do

you feel it is your fault? Are you putting unnecessary pressure on

your child which is causing fear, control issues, tantrums, defiance,

shame, and/or aggressiveness. Motivation by peer pressure (whether on

you or your child) is NOT a good method for potty training SPD

kids... it can do more harm than good and actually delay this

developmental milestone even further.

So, now that we know factors which do NOT work, let's take a look at

how SPD affects potty training specifically; THEN we can address

methods which WILL work.

Signs Of Physiological, Physical, And Psychological Readiness For

Potty Training:

a bowel and bladder that are mature (i.e., can hold larger amounts at

one time and can " sense " the need to void/eliminate

staying dry for at least 2 hours at a time (including nap times)

the child can recognize that she is voiding/eliminating (you can also

recognize they are by their facial expression, posture, place they go

to do it, what they say, etc.)

your child notices and/or becomes distressed by having a wet/soiled

diaper

a " willingness " to sit on the potty (without fear, with or without

diaper/clothes still on)

the child is able to walk to/from the bathroom, get on the toilet,

sit, balance, and get off the toilet or potty chair with little

assistance

able to pull his pants down by himself

can follow simple instructions/directions/commands

is asking to have his wet/dirty diaper changed or to use the potty

your child is having regular bowel movements

It is only AFTER a child is showing most/all of these signs that you

will start preparing them for the big task of potty training. In the

preparation phase (which experts recommend be for about 3 months) you

will begin introducing them to everything involved in potty training.

We will talk about this in particular in the Potty Training Tips

section in a few minutes.

If we carefully look at the signs of readiness, we can see that there

are many ways in which SPD can interfere with potty training. Let's

look at these so we can fully understand what may be going on and why

potty training an SPD child can indeed be a difficult and

developmentally delayed task.

How SPD Can Affect Potty Training

Bowel and bladder readiness is probably the biggest hurdle to

successful potty training. However, it is one of the main problems

our SPD kids face. It is particularly challenging as many don't

understand that THIS trumps chronological age. A child's age will

often mislead us into thinking they " should " be ready. But, they will

NOT be successful until their bowel/bladder and neurological system

is ready.

If an SPD child literally cannot feel sensations from his bowel

and/or bladder, or the sensory receptors of this interoceptive sense

are not picking up or interpreting messages properly (over or under

responsive), the child will not know when/if they have to go the

bathroom, or how to effectively control their bowel/bladder muscles

for elimination. Their bodies truly do not give them the proper input

or signals necessary for effective potty training. It is the same

general concept that underlies SPD... the sensory input, neurological

organization, or sensory motor output are inefficient.

Because of inefficient sensory processing, these children may...

- go rushing to the bathroom at the very last minute (when they

finally feel something) and be too late

- sit on the potty endlessly " trying " , being unable to void/eliminate

despite their best efforts

- be unable to control their bladder and/or bowel functions as the

sensory receptors are not processing information properly

- get easily frustrated, angry, and perhaps ashamed if they have an

accident because they literally could not feel the signals or control

their bodily functions

- become frequently constipated or feel " pain " when having a bowel

movement

- become resistant to potty training beyond 24-36 months of age

- be unable to tell/feel when they need to, or are,

voiding/eliminating; no sense of a " full " bladder/bowel

- be confused, embarrassed, and feel different than other children

his age; other kids may indeed pick on him for still being

in " diapers " or having accidents

- may never feel distressed by a dirty/wet diaper

- fear sitting on the toilet due to poor muscle tone, postural

instability, or poor balance

- be unable to get undressed and get on/off the potty by themselves

due to poor sensory-motor issues and coordination

- may gag or become nauseated by the smell of bowel movements or the

bathroom in general, thus avoiding or fearing it

- be afraid or fearful of the sound of the toilet flushing

- be uncomfortable on a hard, cold toilet seat

- be uncomfortable with the feeling of rubbing toilet paper on

themselves after voiding/eliminating

How To Help The SPD Child With Potty Training

1. Understand their experience may be uniquely different than their

peers and/or siblings.

2. Wait to start potty training until they show the psychological and

physiological signs of readiness we talked about earlier, despite

their age.

3. Go at the CHILD'S pace and give plenty of positive reinforcement.

4. Do not punish or criticize the child for not recognizing their own

bodily sensations and/or if they have an accident.

5. Do not potty train during periods of high stress in the child's

environment (i.e., new sibling, a move, new day care, starting

preschool, etc.).

6. After the child shows signs of physiological and psychological

readiness, begin a 3 month preparation phase (minimum) before

actually potty training (yes, patience will be the key here!).

7. During potty training preparation phase do the following:

- go to the store (or look online) with your child to pick out a

special potty chair

- allow the child to decorate the new potty with stickers

- make a special " big girl/big boy potty basket " with toilet paper

and/or flushable wipes, a book or two, stress/relaxation balls, a

calming cd, aromatherapy spray or oil, and a sticker reward chart

- have the child watch videos and/or read books to them about potty

training (see resources at the end of this newsletter)

- model using the bathroom (preferably with the same sex parent or

sibling) and talk about what you do/are doing

- allow the child to become familiar with the toilet or potty chair,

even if sitting on it with diaper and/or clothes on

- observe the child's behavior and signs that they are going/have

gone in their diaper; make lighthearted comments about it... " Are you

peeing/pooping? " ; " Can you feel that? " ; " Let me know when you want to

try doing it on your special potty chair. " " What does it feel like

when you have to go/are going potty/poop " , " Does your diaper need to

be changed now since you just went pee/poop? " Does your body/belly

feel better now that you have peed/pooped, etc.

8. If the child appears to be fearful of pooping in the potty,

specifically, empty the poop from the diaper into the potty and have

them choose if you or they will flush it down.

9. If your child doesn't appear to notice when he/she needs to go to

the bathroom, try a schedule (for example, every 2 hours, 30 minutes

after a sizeable drink, after he wakes up, before a bath, etc.) No

pressure, just try.

10. Find out what is most comfortable for your child; if you give

them privacy in the bathroom, or if you are in there with them.

11. If your child is NOT distressed by, or asking to be changed out

of, a wet or soiled diaper do NOT use Pull-Ups. They are just as

absorbent as diapers, so they won't feel it with those either.

Instead, pick out some " Big Boy/Big Girl " underwear or training pants

and have them wear those when THEY are ready to.

12. If your child DOES notice when they are wet/need a diaper change,

Pull-Ups are a good next step. They are easy to get up and down, yet

still protects them if they have an accident. THEN graduate to

underwear the more successful they are.

13. If trying underwear for your child, make sure to notice whether

they are bothered by the seams in the underwear. They may refuse to

wear them because they are uncomfortable, not because they don't want

to work on potty training.

14. If your child is ONLY pooping in their diaper (basically potty

trained for peeing) allow them to do so until they are comfortable

doing it in the potty. Try to have them do it in the bathroom itself,

if possible, then on the toilet with diaper on, then on the toilet

with diaper ½ open, then with diaper off and completely on the

toilet. Another good tactic is to take the diaper or Pull-Up off

after they have had a bowel movement and dump the poop into the

toilet. Talk about how that is where it goes, make them feel

comfortable about " letting it go " (be silly; make up a song, wave/say

goodbye to the poop if you want, etc.), and have them decide who gets

to flush it. (Note: most children are indeed bladder and bowel

trained at separate times... one will usually come before the other.)

15. Make going potty FUN with food coloring. Put blue food coloring

into the water. When they pee in the toilet, their success will

change the water to green! Put red food coloring in, and success

turns the water orange!

16. Make " aiming " fun for boys with toilet targets! (see link to

resources at the end of this newsletter) They are flushable, fun,

floating shapes they can use for " target practice " . A great way to

teach them, a fun way to learn.

17. Talk to them about the specific sensations they feel revolving

around needing to go to the bathroom and actually going. Explain why

they have the feelings they do or why it is harder for them to feel

than others. Make them as informed as possible, at an age appropriate

level, about how their body works, what it feels/doesn't feel, what

to do when, etc. Make them aware of sensations and make them

feel " normal " . Also let them know you are there for them and will

help them in any way they need your help. You are in this together

and you will both feel proud when it is accomplished.

18. For the tactile defensive, a padded toilet seat or flushable

wipes instead of toilet paper may feel better.

19. Do not push too hard, force the child, punish the child, make

them feel ashamed or afraid by your actions or words if things are

not going well. Anytime they become significantly resistant and

frustrated, take a break for a week or two and slowly try introducing

it again. Do not let it become a control issue or power struggle!

20. Above all... be patient, be consistent. Give positive feedback,

rewards, and praise. They WILL eventually become potty trained, rest

assured. Remember... THEIR timing, not yours.

BESIDES these tips and tricks, IF your child does have SPD, or shows

many red flags... make sure an evaluation is done and OT therapy is

started. The tricks alone will not help him reorganize his

neurological system. They will make things easier and more

successful. But, when SPD has significantly impacted the

interoceptive sense, OT treatment must be done. It is with

therapeutic intervention to reorganize and " rewire " the brain and

nervous system that we will see the biggest changes in internal

regulation. Specifically, each area of dysfunction will need to be

addressed.

One more thing... so far, treatment that has been most effective for

internal regulation issues is a combination of SI therapy (whole body

approach) and Therapeutic Listening. Studies are desperately needed,

but Occupational Therapy for SPD is our best solution, along with the

tips listed above, for better success at potty training our SPD

kiddos.

As promised, here are the additional resources that will help you

potty train your SPD child. Just click here!