We have been discussing different methods of potty training for the past few weeks. But, what about children that are not developing typically?
The Treatment and Education of Autistic and Related Communication-Handicapped (TEACCH) explain that even in typically-developing children, toilet training is often a difficult skill to master.
While the child may have good awareness and control of his body, there are other factors, such as social factors, that determine how easily toileting skills are learned. Small children do not feel an intrinsic desire to become toilet trained. Rather, they acquire this skill in order to please their parents and to gain the social status of 'big boy' or 'big girl.' This social motivation is a critical factor in determining "readiness" for toilet training.
How might the characteristics of autism contribute to a child's difficulty in learning to independently use the toilet?
- The child's difficulty with understanding and enjoying reciprocal social relationships would certainly interfere with this process. While other 2- or 3-year-olds might be proud of their "big boy pants" and might be happy to please their parents, this type of motivation is rare in a child with autism.
- Given the characteristic difficulties in understanding language or imitating models, a child with autism may not understand what is being expected of him in the toilet.
- A child with autism typically has significant difficulty organizing and sequencing information and with attending to relevant information consistently. Therefore following all the steps required in toileting and staying focused on what the task is all about are big challenges.
- Further, the child's difficulty in accepting changes in his routines also makes toileting a difficult skill to master. From the child's point of view, where is the pressing need to change the familiar routine of wearing and changing a diaper? After 3, or 4, or 6 years of going in the diaper, this routine is very strongly established.
- A child with autism may also have difficulty integrating sensory information and establishing the relationship between body sensations and everyday functional activities. Therefore he may not know how to "read" the body cues that tell him he needs to use the toilet. He may also be overly involved in the sensory stimulation of the "product"— smearing feces is not uncommon in young children with autism. The child may also be overwhelmed by the sensory environment of the toilet, with loud flushing noises, echoes, rushing water, and a chair with a big hole in it right over this water! A further consideration is that the removal of clothing for toileting may trigger exaggerated responses to the change in temperature and the tactile feeling of clothes on versus clothes off.
To continue reading about teaching developmentally delayed or autistic children to potty train, click here to visit the TEACCH web site.
Have you ever potty trained a developmentally delayed or an autistic child? What tips can you share with other nannies and au pairs?
6 comments:
A former charge of mine had sensory issues and the toilet was too loud for him. We allow him to use the toilet without flushing. Teachers at school understand and the aide goes in after him to flush without other kids realizing the issue. I would rather not leave my name for privacy of family.
I met a family with an autistic daughter in an interview one time. It was a lot of work to care for her and the other children. They probably should have had two caregivers since they had a lot of nannies burnout on them. This is hard for kids to deal with under normal circumstances.
Anyway about a year after they got her completely adjusted to using a bathroom without incident she started her period. She rebelled because she thought they were putting her back in diapers when they used the pads during her periods.
We did anything to excite the child who showed little interest in using the toilet. If you are caring for a child like that too I would suggest nannies try to add some food coloring in the water. Urine added to blue colored water will turn green.
Annie Nanny
Madison WI
This is my specialty. I have a college teaching degree in education and psycology and have made it my career to work as a nanny for special needs children and/or autistic children.
First of all, all kids are different. Autism is not a one size fits all diagnosis. So each child is different.
When I potty train special needs children I usually create 'scheduled toileting' as outlined in the book "Toilet Training Without Tears" by Dr. Charles E. Schaefer. This assures the child has many opportunities to use the toilet. Sitting on the potty should occur at least once or twice every hour and after you first ask, "Do you have to go potty?"
Even if the child says no, it is a good idea to take him to the potty anyway.
Now if the child is totally resistant do not force it.
For mildly special needs kids then it might just take longer or you may start training later is all that is different from typical chidlren.
Maria Lopez
Miami FL
I worked with a teenager who was severely autistic: couldn't speak, eat, use toilet. She had to wear disposable under garments, rather than use potty. If new caregivers try to get her to use potty they will have difficulty. So, even with puberty and menses it is not a big deal. She merely eats through a feeding tube which does not create a lot of waste. Aides help elderly all the time. Even with her menses the under garments were big enough to hold everything. Easy and clean. Less mess than most babies who spit up and have accidents of pulling off diapers or soaking through diapers. Not a big deal at all. I think I got the job since most nannies were scared of the job. But it really was fine and am glad to have helped keep her healthy.
This is the one situation when nannies or au pairs should just follow the parent's and professional's advice. Any minor developmental delay means the child will be potty training later than the typical 2 or 3 yr old.Even the healthiest children can wet beds or not use potty properly and still have many accidents even at 4 yrs old. Do not let any child think you are disappointed and it will all work out with your hard work.
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