Beginnings
Begin at whatever age your child begins to follow you into the bathroom (not everyone enjoys the open door policy, but it can be a teaching moment) or when your child begins to dislike being wet or soiled. At first, you may see fleeting moments of interest and occasional intermittent voiding in the toilet. Celebrate these successes, but don't expect the mind and body to connect all at once!
Books and Movies
Media can be helpful, there are a ton out there on the subject. My top favs of each are the Once Upon a Potty book (two versions are available, one for girls, one for boys) and the Bear in the Big Blue House DVD 'Potty Time with Bear'. It has 3 episodes dealing with the subject. Both my sons loved these. Social stories specifically geared towards issues like fear of the toilet or toilet flush, can be particularly useful. Make your own with personalized words and pictures, talk to your OT.
Doll
One of the first things you might try is a doll that wets after you give it some water. There are a bunch of dolls out there as well, they can be both anatomically correct and pricey. Honestly, a cheaper version that is not necessarily anatomically correct does the job just fine. Play with it a lot.
Communication
With children who have speech delays, sometimes a motor action or picture card will do the trick. Teach him the sign for potty (put your thumb up through your index finger and middle finger with your hand fisted and rotate your forearm back and forth - like the Miss America wave) or use a PECS card. PECS stands for Picture Exchange Communication System and consists of small laminated cards that are usually used on a velcro strip. Print out a bunch of picture cards and make them available throughout the house. Sometimes with the additional easy motor action kids will be able to communicate quickly and effective enough to be successful. At first they may rely on the card, but just reinforce talking with the use of the card and eventually they will begin to use the word as well, or replace the card completely with the word.
Visual Schedules
If your child is a visual learner, often kids on the autism spectrum are, try using a picture schedule (sequence strip) for the routine. Visuals can help any child organize the activity! First add the potty into your child's daily schedule at particular times, i.e. morning, evening, and anytime you're going to leave the house. In the beginning, you may want to up the opportunities to as many as once per hour. Also put up a mini-schedule right near the potty that shows pictures of the steps such as:
- Pants Down
- Sit on Potty
- Toilet Paper
- Flush
- Pants Up
- Wash Hands
Over at the sink, you could place one for the hand washing or tooth brushing routines. One of my favorite sites on the web for picture schedules is http://do2learn.com.
Behavior Reward System
While potty training can exist without the use of these, some children who respond well to positive reinforcement for behaviors, or who are in ABA programming, need consistent motivation in a predictable manner. First kind of chart would be a piece of the puzzle kind of thing that included a box that says "I am working for". You can velcro a picture of whatever it is (a toy, trip to McDonald's, hugs and kisses, extra book at bedtime, whatever) in that box. It helps if this chart is in picture form. One of my favorite ways is to have an outline of a train. Each time the child uses the potty he earns a train car, when the train is complete he earns what's in the box. This kind of chart is good to begin with, I would start with no more than 5 train cars.
Once you have that down and you feel your child is ready for more, you can go to a grid chart. Each step of the potty routine is pictured above the top row. Each time he completes a step independently he gets to put a sticker or mark in the grid under that step. You decide how frequently you want to reward - whether they have to complete X number of rows or columns or fill in the whole grid. You can use stickers, stamps, velcro PECS, whatever motivates your child.
Diapers or Training Pants or Underwear?
I'm a big fan of real underwear. When children are in diapers or disposable training pants they do nothing to allow the child to feel the discomfort of being wet, unless they're really really wet. With both my boys I found that when they were in either, they would freely pee and poop in it. In fact, with one of them, the first time he initiated peeing on his potty was when we left him naked with a t-shirt while we were camping. You saw that look on his face when he had to go like, "where do I PUT this?" We told him quickly, "Find your potty!" By the end of the weekend he had peeing down. Pooping took a little longer. We found that keeping both boys in underwear increased their independent trials of the potty.
If you're in a pinch and/or don't want to have a mess when you're out, try putting on a pull-up over the underwear. Kids with sensory issues can have big issues with underwear. Some prefer the traditional character underwear, but for some the tight waistband can drive them nuts. Some kids are more comfortable in boxers or even the old school padded cotton Gerber training pants. Don't stress about using disposable training pants overnight or when you're going to be out for a long time. A combination of disposable pants and underwear will not hurt. And eventually you will find that the disposable pants will be dry too!
As you can see, there are a lot of things you can try to help your child become successful using the potty. Don't let anyone tell you you child cannot be trained. Some kids may take much longer than others, but it is worth trying. It is a major life skill that will help them be integrated into school and society!
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