Grace's note: Healthy Children is provided by the American Academy of Pediatrics and is a great resource for families. The series also includes: Visually Impaired, Spinal Cord Injury, Hearing Impaired and intellectual disorder. Visit the web site to get other ideas.
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A page from: www.healthychildren.org
The issue of when and how to begin toilet training can be particularly challenging for parents of
children with special needs. While no parent wants to push an already
challenged child to perform in ways that are impossible, the sense of
accomplishment experienced when he does succeed in this important aspect of
self-care can make an enormous difference in his level of self-esteem.
Perhaps more than other parents, those who have
children with physical, intellectual, or developmental disabilities can appreciate the toilet-training
process as a way to follow and celebrate a child’s overall growth. Rather than
focusing on their child’s mistakes, which are inevitable in any case, they can
use this opportunity to discover how he learns best and to demonstrate to him
that he is able to progress.
Toilet training works best when parents of children
with special needs have access to the guidance, instruction, and encouragement
of their pediatrician, other trained professionals, or support groups. The
first step you must take is to determine whether your child is ready to
begin.
Signs of readiness are the same
for your child as for all children:
•
Is your child aware of the difference between being
wet and being dry?
•
Can he stay dry for at least two hours at a
time?
•
Can he sense when he needs to urinate or have a bowel
movement?
•
Is he capable of reaching the toilet or potty in time
(perhaps with your help)?
•
Can he undress and dress himself or is he ready to
learn?
•
Is he motivated at some level to take this next
step?
If your child is in a resistant phase, is not ready to
take on a new challenge, or does not yet feel the urge to behave “like other
kids” in this way, you might take some extra time to prepare him mentally
before starting the training process.
If you feel that your child is ready, ask your
pediatrician for her opinion. She can examine your child to offer a physical
assessment and perhaps offer special insight into the particular needs of your
child. She can also provide further information that you may need before
starting, and let you know what types of special equipment may be advisable.
It is also important to prepare yourself emotionally
before you and your child embark on this experiment. Children with special
needs often begin toilet training later than other children, frequently
completing the process at age five or even later. (Of course, children with
severe physical disabilities may always need help with clothing and accessing
the bathroom). Learning to use the toilet can be physically painful to some,
initially incomprehensible to others. Accidents will happen, of course, and you
will need to draw on an extra dose of patience and humor when they occur.
Lining up help from your spouse, relatives, or friends before you begin
training—to spell you periodically as well as to help boost your morale—is a
wise move for your child’s sake as well as your own.
Physical
Challenges
A number of physical disabilities and illnesses can
hinder a child’s ability to become fully toilet-trained or easily adjust to
bathroom use. If your child faces such a situation, you will need to think
about how her disability affects each stage of toilet training and how you can
compensate for this disadvantage. Whether your child is unable to sense the
need to urinate, has difficulty getting onto or staying on a standard potty or
toilet, or must adjust or readjust to toilet use after having used an ostomy
device, she will need extra support from you and her other caregivers as she
learns to master this new skill.
Behavioral Disorders
Your experience toilet-training a toddler who is
behaviorally, intellectually, or developmentally challenged will depend a great
deal on your particular child’s temperament, behavior patterns, and coexisting
conditions. In this arena more than any other, perhaps, the parents’ knowledge
of a child’s strengths, weaknesses, tendencies, and interests will help her
through the process as much as any general guide.
Toilet training can be particularly trying for parents
of children who have intellectual or developmental disorders or who are
behaviorally challenged—including those with autism, fetal alcohol syndrome (FAS), oppositional defiant disorder (ODD), and, in cases when it is
diagnosed this early, attention deficit /hyperactivity disorder (ADHD). Many children
with these conditions may not be strongly motivated, or sufficiently equipped,
to respond to the social reinforcements that work so well with other children
(“What a big boy!”), though small tangible rewards such as candy or a toy can
be effective. Most find it extremely difficult to adjust to any change in
routine. Some are particularly sensitive to touch and other sensory input and
become upset by the frequent pulling off and on of clothing, the physical
closeness with an adult, and the unfamiliar surroundings of the bathroom.
Simply getting across the concept of potty use can be complicated by the fact
that some children with behavioral disorders do not naturally imitate their
parents’ or peers’ behavior, while others learn only through simple imitation
or other concrete, nonverbal demonstrations. Such complications in the training
process mean that early efforts can create a high level of frustration in your
child and may lead to displays of temper, stubbornness, and refusal to
cooperate.
Still, nearly all children with these conditions can
be toilet-trained—though in some cases the process may take up to a year or
even longer. Your first step, again, is to determine whether your child is
ready to start training. There is no point in beginning until you see that he
can stay dry for an hour or more at a time, has regular bowel movements, is
aware that he is about to urinate or defecate, and dislikes being wet or
soiled. It is also important to have your child examined by his pediatrician,
since he may be at a higher risk for constipation or loose stools, which may
interfere with training.
Once you have decided to begin, observe your child and
consider carefully the specific traits, patterns of behavior, and obstacles
that may impact his learning process. If he seems to dislike entering the
bathroom, determine what the cause of his discomfort is—the smell of
disinfectant? the cold floor? the flushing toilet?—and change or neutralize it
if possible (change cleansers, put socks on his feet, move his potty away from
the noisy toilet). If he does not overtly signal the need to urinate or
defecate, does he pause just before voiding or otherwise behave in a way that
will provide you with a cue? At what times, or how long after eating or
drinking, does he usually urinate or defecate? What foods, toys, or other
objects is he most passionate about? (These can be used as tangible potty-training
rewards, which may prove more effective than praise.) How does he learn
best—with firm but gentle physical demonstrations (being placed on the potty at
regular times), a formal routine containing a series of simple and predictable
steps (verbally explained and reexplained, illustrated with pictures, or listed
on a chart), or offhand comments and conversations that inform without inviting
resistance?
Once you have made the necessary adjustments in your
child’s environment and your teaching style, it is time to start working toward
his first success. Some parents like to begin the training process with actual
potty use—putting their child on the potty at a likely time and rewarding him
when he uses it. Others—particularly those with a child who resists entering
the bathroom—may want to focus on preliminary steps first. They may start by
rewarding the child for entering the bathroom, then for approaching the potty
or toilet, then for sitting on it, and finally for using it. To make this
process easier, and to avoid the physical closeness that your child may resist,
consider letting him wear only his underwear at first, or even nothing below
the waist. Handling clothing can be taught at the very end of the process, once
the bathroom routine has been accepted as part of his day.
Your child is likely to be resistant to adopting this
new habit. It’s important to insist, however—firmly but matter-of-factly—that
he try. When accidents occur, point out that you disapprove, but don’t punish
or criticize your child for making a mistake. If he is verbally challenged, be
sure to stick to simple instructions such as “Wet! No!” As he gradually gets
better at using the potty—motivated for the most part, perhaps, by the prospect
of a tangible treat—your child’s love of routine will begin to work in your
favor. He will expect to visit the bathroom at predictable times and may even
become upset if this doesn’t happen. Until then, you will need to remind
yourself how difficult this major step forward is for him. You should also think
about how to find support for yourself as you search for the patience you
will need to succeed. Both you and your child are embarking on a difficult
developmental task.
Last Updated 5/1/2012
Healthychildren.org
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