Wiz was not for my intelligence or insight. No, it was for my skill in...drum roll please...
(You now see why I received a yellow cape)
Toilet training, in my experience has been the most frustrating few weeks, months, and in some cases, years for the parents and families I have worked with through the years. The pull-up, diaper, and changing bag are the items no one wants with them everyday of their life. Individuals with disabilities are no different. Often, when i meet with an incoming family, their first concern is related to toilet training. Needless to say, after 19 years I have developed a program for students in my program who still need to become independent in the bathroom. All children are different so I have to modify it a bit for each student but there is a basic plan I begin from and it has been successful, so far. I thought I would share it in hopes of refining it further with your experiences.
Toilet Training Program for Children with Special Needs
Toilet training is one of the most critical elements to a student’s independence and yet, is also a frustrating thing to teach for the child and the parent/teacher. Here is an approach that I have used with good success. Not all children are the same so the amount of time it takes can vary but it will happen…have faith.
Things you need to know (how to find the answers is described below):
1. What are the biggest daily motivators for the child
2. What the child would like most to earn as a “big kid”
3. What are the times that the child’s body needs to use the restroom usually
4. How long can a child wait?
Biggest Motivators (Questions 1 & 2):
You probably already know what your child/student enjoys most but in this case it needs to be motivators that you can withhold until they are earned. If the motivator is an iTouch for example but they are using one of the communication apps such as Proloquo2Go, this is not a good motivator for toilet training. It can be as small as a high five and as big as time on the computer. This is very personal. You may, for some children need to provide a menu of reinforcers they can choose from if they are not consistently motivated by one thing. Again, this needs to be a list of things you can withhold.
Time Issues (Questions 3 & 4):
To determine what time the child’s body naturally needs to use the restroom and how long they can go between visits, you need to collect data. Don’t worry, this is very easy. Each day, write down the times you took the child to the bathroom and whether or not they went at all. Also, write down any time that the child goes to the bathroom in their pants. This is far easier to be accurate if you have the child in regular pants as it is very hard to know when they have an accident in a pull-up. However, sometimes, you have to use a pull-up. I understand and appreciate this, it is just not my recommendation.
After 2-3 weeks, you will see a pattern of times that you will note as naturally the time to use the restroom. It may be a window of time but the closest you can narrow it, the easier for you in the long run.
Step 1: Create Schedule for visiting the restroom using the data above.
Step 2: Find a new home for the reinforcers that only adults can reach. This is their new “home” so you are now the one who can provide the item/time reinforcers when it is earned but also put it away when it is lost.
Step 3: Put a schedule of the month somewhere in or near the restroom along with stickers. This is now the goal for the “big kid” reinforcer. Depending on the size or cost of the reinforce, you can create an amount of stickers the child needs to earn to get it. I usually start with 20. The child earns a sticker for a perfect day using the restroom. Only for a perfect day. If the child has an accident in their pants, write a sad face on the day right away so they see that it is a sad choice. Then proceed with the rest of the day following the rest of these steps. Please note, if the big reinforce is getting close, you need to make sure you can honor it within 48 hours of the child earning it. For instance, 20 stickers=a trip to a restaurant. You need to go once the child earns it, even if they have made other poor choices as they DID earn this one. It is most powerful if they can only get the reinforcer when they earn it but I understand that birthday parties, family get-togethers, play groups may choose the same thing. That is okay, just make sure when the child earns it to restate that to them throughout the time you are there.
Step 4: Assume success. If the daily reinforcer is access to a computer, tv, or other electronic device, a toy, room, or materials like markers or crayons, they should have it until they lose it. Again, only use reinforcers that are not also communication devices. If it is a piece of candy, sticker, marshmallow, high five, etc., they only earn that once they use the toilet successfully.
Step 5: Take the child to the bathroom. Upon entering, review the calendar and what they are trying to earn. For example: “Look, you can go to Red Robin if you earn 20 stickers. Here are the stickers you need to earn. You have to go in the potty all day to get your sticker. Boys/Girls who go potty in their pants do not get Red Robin (make a sad face). Boys/Girls who go potty in the toilet can earn Red Robin (make a happy face). Let’s see if you can use the potty.”
Step 6: Try to be as quiet and inconspicuous as possible while the child is on the toilet. Most children will try to engage the adult through talking, pointing to things, trying to play but if you can, ignore as much as possible so the child gets the message that on the toilet, they have job to concentrate on. Wait 3-5 minutes (longer if the child has Cerebral Palsy as they need time for their body to listen and react).
Step 7: No luck. Remind the child about their “big kid” reward on the way out and that they need to be big and keep their pants clean and dry.
Step 8: The child uses the toilet—HOORAY! This is big, make it a big deal. For example, I am famous for my “Potty dance.” If the child has a daily reinforce such as candy, stickers, high five, etc. get it to them immediately. If it is an access reinforce such as computer, TV, etc. Tell them, “You can go play ______ because you were so big and went potty in the toilet.”
Step 9: The Accident. Yep, they will still have some accidents. At the moment of the accident, they have now lost any access reinforce such as computer, TV, etc. Tell them so but briefly and concisely. Example, “So sad. You peed in your pants so no more computer. I am putting it away.” Then go right to the restroom. To the extent possible, the child needs to undress and dress themselves. They also should sit on the toilet for a minute or two. Some children will then go again. Just remind them that they peed/pooped in their pants first so that is sad. Also, write a sad face on the “big kid” calendar.
Step 10: Get right back on schedule. The next time the child visits the restroom dry and clean AND uses the toilet, they get back any access reinforce or daily reinforce. The idea is, when you are big, you get big stuff. When you are not, you don’t.
Step 11: Accidents while sleeping, one extended car or plane trips, or extended bus trips such as field trips do not count against the child. In fact, these are the times I support the use of a pull-up as the child has no control of the situation.
Step 12: Tomorrow is another day. Each day, start fresh. At the beginning, you may have accidents every day but the time of the accidents will get alter and later until they disappear.
Some of my favorite daily reinforcers:
Access to movies and/or TV
Access to a trampoline/back yard
Access to marker instead of only crayons
A song and dance together
Juice instead of water
Getting to be first in line, at games, etc.
Small food items if the child is only motivated by edible things
Some of my favorite “big kid” reinforcers:
Going to buy “Big kid” underwear together that is fun designs
Baskin Robbins or another frozen treat
A lunch date to Subway –as a teacher, taking the kiddo to lunch is VERY powerful and motivating
A trip to the local indoor pool
A movie at the theater or a 3D movie
A trip to a favorite activity place such as indoor jumping, a favorite kid-friendly restaurant that includes video games or things we can do together, bowling, swimming, a museum. (For one student, going to see the dinosaurs at the museum was worth 50 days meeting his goal!)
Good luck, have patience, and believe that anything is possible. IT IS!!!