potty training for a 10 year old

[teacher229]

I am attempting to potty train a 10 year old autistic boy.   It was a struggle to get pull-ups on him because it was a change in his routine.  He had to start removing his shoes and pants in order to use the pull-ups.  We have the pull-ups that get cold when they get wet.  He'll tell us when he needs to go to the bathroom only to find that his pull-up is already wet.  We've been tracking our trips to the bathroom and have started bringing him to the bathroom before he is wet around 15 - 20 minutes before.  We make sure he drinks about a sippy cup full of water at least 10 minutes before going into the bathroom.  We then bring classwork into the bathroom in order to get him to sit.  He likes us to sing to him but we tell him we'll only sing to him when he goes pee in the toilet.  
We need some help.   The child doesn't have any medical diagnosis or bladder problems that prevent him from being potty trained.  The reason he hasn't been potty trained is because of the familiy's dynamics and it has gone through multple changes.  
What else should we do?  Should we move away from pull-ups and into cloth underware with the plastic liners?  He doesnt' understand what to do on the toilet.  We've asked the family to bring him into the bathroom with them so he can watch and learn - but they are private and don't want to do this.  
Any suggestion  

[Rebecca_L]

Yes, we kept that in mind when we first took away the video games from him. But since his accidents dropped off dramatically after we did we think it is an effective reinforcer. We don't take them away for longer than an hour either. It seems to work well as an incentive to be more aware of his body's signals, but I'm well aware that not all children with autism would be as sensitive to their body as Aidan is. It's one of the big challenges to raising our special children, isn't it? ;)

[Sally44]

Having read your post I just wanted to add something.  It is true that children with autism can forget about everything else if they are a bsorbed in doing something and may not feel hunger/thirst/needing the loo etc.  But I also wondered if you had considered sensory issues as well as if some of his senses go hypo (undersensitive), it can have the same effect.  This effects internal sensations as well such as hunger/thirst/feeling hot/cold/needing the loo.  Most children on the spectrum have some kind of sensory processing difficulties, and it is also useful to know that their perception through their senses can fluctuate day to day and throughout the day.  So my son might cover his ears at noise, appear deaf, showing sensory seeking behaviour of making noise etc all in the same day.  This is because his auditory sense if fluctuating between hyper and hypo sensitivity.  The children are not in control of this perception and therefore reward or punish strategies will not work.  However adapting their environment so that they are either not too overstimulated, or if they are hypo introducing more sensory stimulation can show great improvements.

[Rebecca_L]

We have just about managed to potty train my 5 year old grandson with autism so I'll share what's worked for us and you can pick anything that makes sense to you. First of all, we got a potty chair and placed it in the rec room where the boys play and watch tv. We had Aidan sit on the potty chair often throughout the day and if he actually peed we made a very big deal of it and he got one M&M or Skittle or other piece of candy. (He loves his candy.) We also got a book and DVD from our local Autism support group called The Potty Book and DVD for Boys. We watched it. (It drove us adults half insane. They sing "Bye bye pee pee, bye bye poop!" ack But Aidan loved it. He loves songs too.) Our biggest breakthrough came when we had no pullups and went through the day in underwear. We watched Aidan like a hawk, hustled him to the potty as soon as he started to pee, sat him on the potty every hour or hour and a half, Dad showed him how to pee in the potty, and, most importantly I think, convinced his younger brother to start using the potty. (I honestly think that might have made the biggest difference, but I don't know for sure.) Of course, the school was working on it too, which helped enormously. Now Aidan will go and use the potty, although he has accidents a lot especially when he's playing video games. I think he just gets so absorbed in the games he doesn't realize he needs to go but at least he recognizes when he wets now. He loses video games for an hour if he has an accident while playing, and that's been a great motivator for him to pay attention to what his body is telling him. He also gets two pieces of M&M or Skittle or whatever for 1) using the potty and 2) not wetting his pants.

A warning, though. We told Aidan over and over again "Poo poo goes in the potty, not in your underwear." Well, Aidan pooped in his underwear one day scooped it out, carried it into the rec room and placed it in his potty. Now we tell him "Poo poo goes in the potty first! No poo poo in the underwear at all!" Never underestimate the literal interpretation of the child with autism.

[sneh21]

Potty Training Guidelines

1. Buy lots of the child’s favorite drinks and salty foods.

2. Make sure the “ultimate” reinforcer is available to the therapists/parents for the child’s successes on the potty.

3. Buy regular underwear

4. Buy a potty seat that fits on top of the regular toilet and a stool for the child to rest his feet.

5. Prepare activities for the child to do while seated on the potty such as; puzzles, books, manipulative toys.

Day 1

1. When the child wakes up, dress him/her in a shirt or sweatshirt, underwear and socks

2. Makes sure all SR+ items, activities, drinks, salty foods and the potty area is set up.

3. Begin giving the child liquids (LOTS!) for about 5 minutes.

4. Continue giving the child liquids until he/she is on the potty.

5. Start entertaining activities such as singing songs, puzzles, toys, etc.

6. Keep the child on the potty until he/she is successful. This can be a long time, 1-2 hours. This time will be this days baseline time.

7. Once the child is successful, reward the child greatly verbally and with his/her ultimate reinforcer item. Let the child off the potty for 10 minutes with his or her underwear off in the bathroom area. Continue fluids at this time.

8. Once the 10 minutes are up, put the child back on the potty until he or she is successful or the baseline time is up. Whichever is first.

9. If the child is successful, reward him or her greatly and let the child off the potty for 10 minutes in the bathroom area. If the child does not go, let him or her up for 3 minutes in the bathroom area and then bring the child back to the potty.

10. Continue these steps until the child has 3 successes on the potty.

11. After 3 successes, decrease the amount of fluids and gradually increase the amount of time off the potty by 3 - 5 minute increments. Remember to keep the child’s baseline time documented on the potty chart.

12. Continue with this for the rest of the waking hours of that day.

Day 2

1. Re-start the entire potty training procedure to get a new baseline time for the day. Each subsequent day you should see a decrease in the baseline times. At some point, the child should go as soon as you set him or her on the potty.

2. Continue with this for the rest of the waking hours of that day.

Day 3

1. Re-start the entire potty training sequence to establish the new baseline.

2. Use the amount of time from Day 2 off the potty time and let the child be able to go into 2 rooms of the house supervised.

Consequence for Accidents

Have the child clean up the accident with hand over hand prompts. Have the child rinse out his/her clothing and get dressed. Put the child back on the potty. Add 10 minutes to the time the child sits before the baseline time begins. In essence, the child sits on the potty longer.

GOOD LUCK! Remember to be patient, potty training can take up to a week.

God BLess,
Sneh
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[kat77415]

I have a 6 year old autistic son who is rather high-functioning academically but is still no where near potty trained.  This summer he just started to recognize when he needed to go but only when I put him in underware.  If he is in a pull-up (even the ones that are supposed to get cold) there is absolutely no recognition - even if he wets all the way through his clothes etc. The problem then is that he really really doesn't want to go on the toilet.  He gets extremely agitated if I even mention sitting on the potty.  I also have a TV tray in the bathroom and let him color on the potty to help keep him in there because otherwise he will touch the seat and then hop up.  I have also tried to put a warm towel on his lap to increase privacy and to help him relax.  So far, nothing has worked.  He doesn't seem to have any aversion to the bathroom itself, just using the toilet.  

[MJIthewriter]

Sounds like the boy will have to learn what it feels like in his body before he has to go in order for him to know when.  But that's where the real challenge is. That's something I don't know if there is anything out there that can mimic the sensation of having to go pee, so one can learn that's what that signal means.

With me I can feel the urge to go pee, but it tends to be rather close to the time I really have to go, especially if I get caught up in something and don't want interruption. It seems when I'm focused I will forget to eat and forget to sleep...  Eventually I do feel hungry, but at that point I am starving hungry (feel that way) and want food immediatly.  With sleep, I pretty much have to feel like I am about to collapse before I really sleep. Otherwise it seems I don't know where to put my arms and legs.  No matter where I set them I feel the urge to move them or they cramp a little.

[teacher229]

Yes, he will tell us when he is thirsty and ask for his favorite food.  Thank you for all your suggestions.  I will let you know how it goes.

thanks a ton

[Sally44]

I've been thinking about this overnight and I think you should get a better idea of if he can actually feel internal sensations if he can also tell if he is hungry or thirsty.  So does he request things to eat or drink or does he appear to go for long periods without asking for something to eat or drink, or does he fluctuate between the two.  This will give you an indication of whether his internal sensations are hyper/hypo/normal or whether they fluctuate throughout the range day by day or even throughout the day.  If he does appear to be able to tell when he is hungry and when he has eaten enough then it is logical to assume that he may also be able to feel when he needs the toilet.  That being the case then it would involve lots of visuals, social stories, explanations and examples and for them to be as precise as possible and to explain the whole of the process and not just parts of it.

[Sally44]

I'm not a professional, just a parent with a child on the autistic spectrum.  
Do you know what his non-verbal cognitive ability is?  It can be easy to assume low IQ with autistic behaviours and speech disorders which is not necessarily the case as shown by autistics like Amanda Baggs on Youtube.
I suppose that if using a book or similar helps him understand that he has to stay where he is for a while, then it is serving its purpose.  Many times you just have to go with what works.  And nothing is ever written in stone.  Routines/supports/strategies can always be changed.
What about if the 'reason' we go to the toilet were explained to him ie. that it is taken away down the pipes and what happens to it etc.  
I've just heard about SCERTS myself and am hoping they will try this with my son.  It seems a good way of getting everyone involved working together to meet targets, which should also highlight his problem areas.
It is a pity that no male family member can actually show him how to pee in the toilet.  I presume male carers or TAs can't do that as it would be considered inappropriate???
Although my son was potty trained at 3, he has only recently became independent on the toilet (he is nearly 8).  We had been at a stage where he was semi independent for a long time, but I couldn't seem to break the routine of him shouting me to come and check that he had wiped himself properly.  But through using the visual symbols on a board at school he was able to remember and follow all the steps independently and just stopped shouting me when he used the toilet at home.
But my son still finds it hard to urinate standing up.  Again I think it is a sensory issue.  He has to sit down.  I think Donna Williams said that she used to go at set times during the day because she didn't 'feel the urge to go'.
You could try him without diapers, but what do you think his reaction would be?  I think you would have to try all the other things first eg. symbol routine, social stories, explanation of the sewage system etc first.  The next stage would be social stories about growing up and not needing diapers anymore.  
Although he is 10 I don't think that is extremely unusual for children with autism.  He does have the rest of his life to learn this skill.  
But this child's difficulty seems to be in understanding that he needs the toilet 'before' he wets himself.  He seems to see the bathroom as the place he changes his wet diaper.  Is it the same with #2?  If so, then I would suggest you need to find out 'if' he can feel and understand when he has the 'urge' to wee or poo as that is an internal sensation as opposed to feeling wet which is an external sensation.  But I don't know how you would achieve that.  But does that sound logical?

[teacher229]

Thank you for alll your suggestions.  We are doing SCERTS with him not ABA.  However, we do incorporate ABA with him for his behavior management and are trying to teach him to regulate his behavior outbursts.  If you google SCERTS you can find out more information.  

The reason we are doing school work in the toilet with him is because we need him to sit and stay calm or regulated.  He use to go in the toilet and scream and hit and yell because of a poor experience at home/pervious school.  We use to sing to him because he really likes music but then we thought he was associating the toilet with the singing which is why we switched to doing school work.  At first, he wanted the songs but we kept telling him that we would only sing to him if he went pee in the toilet. We thought that motivation might work.  I don't believe he understands what he suppossed to do.   I love the idea of watching a video of a little kid going to the bathroom.  I hope one exists.  I'll have to do a search on YouTube.  
He learns concepts very quickly.  At one point his sister was watching him with her boyfriend and they were apparently having a make-out session because he always tried to kiss her on the lips like the boyfriend after that.  
I will also try the picture schedule with him.  He follows picture schedules very well and will notice a change in his routine automatically by the order of the pictures - he does fairly well with transitions.  
Should we stop doing school work on the toilet?  If so, then how do we get him to sit for a long period of time like 5-10 minutes.  We tried using a timer but the longest we could get him to sit was 2 minutes and anything longer he would start to get deregulated or frustrated and start to cry and hit his head.  Which is why I believe he doesn't understand what he's suppossed to be doing?
We have just started social stories and I'm hopeful that will work and he learns concepts very quickly through observations and repition.  
I wish we would have had him earlier.  He came from out of state where he only went to school1/2 time and it was pretty much daycare.  They didn't have a program set up for students with severe disabilities.  He was placed in a resource room (all they had) and was "baby sat" the entire day.  Since he came her 1 year ago his languge has increased 100% and his behavior outbursts have declined immensely.    
I know this is going to take a long time.  Do you know of anyone else who has tried to potty train this late?  

[Sally44]

My son is not as severe as this child sounds.  But he has found it helpful to have a picture board of what he is supposed to do and in what order.  To begin with he would work through the process one picture at a time.  Now he just needs to look at it before he goes into the bathroom.
I am not a professional, but some of the things you are doing sound to me like they might confuse him more eg. associating school work with the toilet?
If he has sensory issues he may not even feel when he needs the toilet.  There are many verbal adults eg. Donna Williams, who have talked about this.  Internal sensations such as hunger, thirst, needing the loo etc are controlled by the senses.
Is there anything about the bathroom he might not like.  Is it cold, or a colour he hates. Is there a hand dryer that might make him anxious if he doens't like sudden unpredictable noise.
As he can tell you when his pull-up is wet, it does sound like he has some understanding of the wet sensation.  But he has learnt that you go to the toilet when he feels wet.  
As alot of autistic children like TV, have you tried letting him watch a film of a child going to the toilet?  I don't know where you would find one though! You could then try with pictures and seeing if he can put them in order.  One of the pictures needs to be a boy in a wet pull up, to see if he can understand the concept of using the toilet 'before' the wet pull up.  Can you get advice from an Educational Psychologist about how to go about this?  At my son's school they do use 'change' symbols to show the children when something different is going to happen.  
You also don't say what this child's cognitive level is.  That can be very different to the level of ability demonstrated by the autism.  Could he understand Social Stories?
I'm just brainstorming here, but I think you need a specific programme putting together by someone who has experience of ABA.