Extract from Behaviour Skills Parents, Teachers and Support People – A focus on Autism, by Trevor Lewis
Toilet training could be one of the most stressful events parents and children go through in the early years. Yet it need not be a drawn out issue, and in many cases – even with developmentally delayed children, can be resolved within a week, and sometimes less.
The three strategies outlined in this book can be used with typically developed children or with children with an intellectual or developmental disability. Also included are short chapters specifically addressing issues faced by Parents who have a child with autism, or with an intellectual disability. Parents of neuro-typical children may also find some of the information in those chapters is also helpful when addressing specific issues their child may be having with toilet training.
Important Issues
Before you decide to embark on a toilet training mission with your child, you need to give some thought to the following:
- Is your child at both a chronological and developmental age where you can reasonably expect her to accept and be able to learn all the facets that toileting consists of?
Interestingly when researching the average age that a typically developed child is ready for toilet training, I found a wide range of ages quoted. Anywhere from 18 months to 32 months were recorded as so-called ‘average ages’. However, by far, and in agreement with our own knowledge, around 24 months of age for girls, and slightly older for boys (28 months) would be the average chronological age. Keep in mind if your child is developmentally delayed, she may need to be older before she is ready for this training. Also remember that every child is different! There is not necessarily a right or wrong age to toilet train. Different cultures also vary with toilet training ages. Many children with autism may not be fully toilet trained up until they are 4 or even 5 years of age due to developmental considerations and challenges. However, I recommend that at a maximum age to at least attempt a toilet training program with – for any child disabled or not, is three and a half years of age.
- Is your child having longer periods of dry nappies?
If they are now waiting up to 3 hours or so before wetting, that would indicate they have at least some bladder control, and it is likely they can differentiate between a dry nappy (pants) and wet.
- *Disposables verses cloth nappies.
*A little to late now to make any changes, however keep in mind that disposable nappies are now very effective in keeping moisture away from babies skin. So, if your child has been wearing only disposables in the months preceding your embarking on toilet training her, you may have a slightly tougher time.
Cloth nappies, obviously by the nature of the material, are immediately dampened when a child urinates, and so the child can sense the change from dry to wet, thus aiding their understanding about voiding (toileting). However, do not be dismayed if you have been a firm user of disposables for your children (as the authors have been with most of theirs) all is not lost!
- Potty or toilet?
Please, please, please …… forget using potties! The number of training books and leaflets so called ‘child-health experts’ write, who start off any toilet training advice talking about using a potty, is surprising and a little frightening. I strongly recommend that unless there is a specific physiological reason, or your child is disturbingly terrified of sitting on the toilet, you do not use potties and DO use the toilet itself as the first and only toileting equipment. It makes no sense to spend much time and effort training your child to use a potty, to then only spend more time moving her from potty to toilet bowl. For those still not convinced, think it through logically. Remember when you first learnt to drive, did you spend hours upon hours sitting on a kitchen chair with a toy steering wheel and a wooden spoon gearstick, ‘learning’ how to drive, or did you start first off in a driving instructor’s vehicle (or a brave family member’s car!)? However, there are toilet seat inserts, that make the seat area smaller (so the child feels more comfortable and secure – and doesn’t fall down the hole!).
- Is your child currently compliant with most reasonable requests made of it?
If your child will come to you when you call, and follow a basic request like “pick up the spoon” or “put kitten down” on at least 50% of occasions, you can accept your child is at least averagely compliant. This will certainly help the toileting process, as requests to stay on the toilet or to wipe their bottom will be made by you and you will have your, and their stress levels greatly reduced if you have reasonable compliance. If you currently have little to no compliance from your child, these strategies will be difficult to implement. If you feel that your child complies with little to no requests you make of it, more common with children with moderate or worse autism and other developmental delays (though not unique to), I suggest you refer back to the chapter on obtaining compliance (Chapter #) before you begin on using any of the toileting strategies. However, do not rule out toilet training at this time if you feel your child is far from compliant, you may still have success using the strategies supplied as they are designed with the most challenging child in mind.
- Which of the three strategies should you use?
This is really only a question you can answer. The strategies all follow the same basic principles of scheduling (whether it be fixed or to responses observed), and reinforcement. Yet one child may respond quickly to one strategy and not at all to others, where another child may respond to the others but not to that one. I suggest you read through each of them, discuss with your partner or fellow support person, and decide on which one is more likely to succeed taking into account your day-to-day demands of life, and your child’s challenges. Though there is no reason you cannot try one, and then another if you appear to be having no success, I do recommend you give some thought to the one you try first, because if it backfires and turns to disaster this may influence your child’s future thinking about using the toilet and make other attempts at training more difficult. Also, strategy three (‘Sit and wait’) is more aimed at children who may be having some trouble with identifying the bladder full sensation or the sensation before a bowel movement. If you really cannot decide, and feel this really is going to be a mission, I suggest you trial strategy One (using the ‘Dior Method’), as this uses some extra principles to the other two, that in most cases will see quick success – though a little more energy draining for the parent or support person!
- Equipment?
Other than a standard toilet, and maybe a fit-in-toilet seat for toddlers, you need nothing else but lots of patience and a calm demeanor. Remember, I advise against potties.
The ‘Dior Method’
This ‘Dior Method’ relies on your powers of observation, and more importantly on how well you know your child’s behaviours, and behavioural cues. That is, being able to recognise what your child usually does just before they void. This may be a certain facial expression, total silence and/or stillness, taking themself to a corner of the room, holding their groin area, a certain movement or posture, etc. If you do not already have an idea of what your child does just before voiding, you will need to carefully observe them over the period of a day or two, taking mental (or written) note of what they did just before they wet or soiled their nappy.
This strategy is one that needs to be run over two or more consecutive days until you have reached success. It is not recommended for just an hour or two now, and another hour later – maybe tomorrow. So plan what two days (maybe more) you will have your child at home with little to no distraction. Preferably days where you do not need to rush off at some stage, and have to put nappies back on the child before you have reached the stage where you want to be that day. In saying that, you can plan for an outing that day as long as you have finished the work for that day (nappy off time) with a success, voiding in the toilet.
Step One
This strategy uses what I term The ‘Dior Method’. What this means is, it has had specific strategies added to it that will help the process being learnt. The ‘Dior Method’ uses scientifically based principles of positive reinforcement, combined with repetition, environmental enhancement and behaviour analysis. Don’t let these terms baffle you or concern you, these principles are simply added into the strategy that you are about to read through – and then implement. ….
To read the full strategies, and get a lot more information relating to behaviour and autism, purchase your copy of Behaviour Skills Parents, Teachers and Support People – A focus on Autism, by Trevor Lewis HERE