Toilet training is one of the few self-care skills that fall primarily on special needs parents. Speech therapists, feeding therapists, occupational therapists and ABA instructors all do assessments and create plans. Hints on toilet training from your therapy team are often very helpful, but “the boots on the ground” are yours as a parent. You are the one that deals with it when *&%$ happens, as it most certainly will!
Many parents find themselves with children that do not cooperate or become defiant to the entire process of training, regardless of their level of cognitive, sensory or motor involvement. A child with profound issues can cooperate well, and a child that is in a integrated class can be steadfast in not participating. What gives?
- Sensitivity to multi-sensory input: The noises, smells, even the lights in a bathroom can be mildly to very irritating to sensitive children. They may not verbalize it, even if they have lots of language; they just want out. Try to minimize what you can, and use the sensory calming techniques your OT has shared. Ask for all her good ideas!
- Sensory seekers that aren’t motivated to remove wet or smelly diapers, don’t register the experience, or actually want to explore what is in that diaper. Some children are at the other end of the sensory spectrum, and may not find the odor and feeling of a soiled diaper offensive or even that noticeable. See Pull-ups do a wonderful job of reducing the sensory input, so try training pants with a leak-resistant cover. Just like a younger typically-developing toddler, some ASD and SPD kids “smear”, which is exactly what it sounds like: decorating the room and/or themselves with their feces. This is a behavioral issue with older children, but it also suggests that the motivation to get trained isn’t going to include wanting to be rid of the diaper and it’s contents.
- They dislike being exposed to room-temperature air, and wiping/being wiped. These kids probably have always dislike diapering. They might avoid you after they have had a bowel movement to avoid being changed. You may have had to become an expert in the “fast change” so that they are not totally hysterical. Well, sitting on the pot with their pants off for a while and learning to wipe might be even harder than being diapered. Try warming the room, get a warmer for the wipes (these exist) and make sure that you communicate that this doesn’t mean they have to sit there for a long, long time.
- They hate the feeling of the clothing sliding over their legs. Time to work on reducing their tactile sensitivity. It can be done; ask your OT. And find some super-soft clothes for the toilet-training period. Fleece shorts, anyone?
- Sitting on the toilet seat feels like they are perched over a big scary hole. Children with poor spatial awareness or poor proprioception aren’t good at judging how large the opening is or how deep. Add some instability with low tone, and you have a recipe for fear. Then flush the toilet while they are still sitting, or standing nearby, and that potty seems like it could suck them down! Try a potty seat and gradually move them over to a toilet once they are confident and independent there. Do more homework exercises on core stability and postural control, and don’t forget vestibular activities from OT. And consider a child-sized toilet in the bathroom they use most Should You Install a Child-Sized Potty for Your Special Needs Child?.
- Without a clear sense of time, sitting there seems like it takes forever. Kids can have no sense of how long something they don’t enjoy will take. Use a visual timer, the microwave timer, or your smartphone timer. My iPad has a visual countdown clock to see when time is up.
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