We are going to deal with the topic of Potty training, about diapers for our nonverbal children, in several posts for this blog. Because we know it's a topic that concerns you and often takes up a lot of your time.
For this reason, we want to capture the most relevant points that Cristina shared in the last Webinar of the VICON Method, which if you want to see you can see on our Facebook profile here.
So, we're going to present it to you point by point so that everything is well-defined... Let's get started!
- Potty Training
Yes, leave (not remove). In fact, I'm sorry to say that they don't "learn" to control them as such; it's a developmental milestone, just like starting to walk.
But if we still want to To be successful, there is no other option than to do it when the child is ready. Regardless of the season, whenever it suits us, it has nothing to do with our timing, but with theirs. For various reasons, many parents are forced to begin a diaper-free period the first summer after their child turns two. Due to pressure from preschool, social or family pressure, and, of course, the pressure to start school without a diaper. As we know, The maturation and development of children changes a lot in a short period of time, especially in the first years of life. It's also very important to do it as a team. So agree with the nursery school and your therapists to follow the same approach regarding potty training. We want our child to feel confident in adults, but we need to make the decision coherently and based on their time, not yours.
2. THE WHEN
A typical child will be potty trained between 18 months and 4 years. In children with ASD, SLI and comprehension and communication problems, the difficulties are added… In fact Most children with ASD learn to urinate and have bowel movements on the toilet later than other children.
Every child with ASD is unique Of course, these children often also have some common problems that can make toilet training difficult. It's very important to be aware of these problems to help you think of ways to meet your child's needs.
Consider the following topics:
- The Physicist: There may be a physical or medical reason for toileting difficulties. Discuss these issues with your child's pediatrician. It's very important to look for associated motor disorders that may be making the process difficult.
- The Language: Children with ASD have difficulty understanding and using language. Don't expect an autistic child to ask to use the bathroom.
- Dressing: Some children with ASD have difficulty pulling their pants down or back up.
- The fears: Some children with ASD are afraid of sitting on the toilet or of the sound of flushing the toilet. Getting your child used to the toilet using a visual schedule and incorporating it into their routine can reduce this fear.
- Body indications: Some children with ASD may be unaware that they need to use the toilet, or that they have wet or soiled their clothes. Sensory issues are associated with this.
- Need for consistency (i.e., routine): Many children with ASD already have their own way of urinating, defecating, or bowel movements. It may be difficult for them to learn a new way.
- Using different toilets: Some children with ASD learn to follow a bathroom routine at home or school, but have difficulty using the bathroom in other settings, such as public restrooms.
In short, finishing refining concepts and procedures, it is very important to know the basis we have to be able to establish the "Training by Visit" or the "Scheduled Training" that allows children to learn to use the bathroom alone without imposing other demands on them.
3. SPHINTER CONTROL
It's important to clarify a few concepts before starting the topic. These are the sphincters. They're circular or ring-shaped muscles that allow a substance to pass from one organ to another through a tube.
So when we talk about infant sphincter control, it is that physiological, muscular ability to control and contain the anal sphincters (of the butt) responsible for defecation, pooping, and the urethral sphincter, which is responsible for controlling and containing pee or urine.
4. MUSCULATURE
This fact brings us to a very important point that almost everyone overlooks. We must understand and be very clear about what it is. the functioning of the bladder muscles, although it may seem unbelievable, it is very important to understand that the muscles work the opposite way to the other muscles of the body, the ones we use pressure to grasp and relaxation to let goThe detrusor muscles involved must contract to retain urine, and that's my first point: muscle tone is an essential prerequisite. Low muscle tone can work against us in the development of these muscles and is a consequence of sphincter control.
Therefore, it's very important to consider our children's muscle tone, including supplementing with sports activities, abdominal exercises, gluteal exercises, and pelvic floor exercises that can enhance the physiological development of the muscles involved in this process.
5. RELAX
On the other hand, considering that for sphincter control to occur and for our child to pee on the toilet, he or she needs to be relaxed, the first thing we need is for the environment, the bathroom and the toilet to be a relaxing space, without fear, without stress... What brings us the relaxation we need for our children to pee on the toilet.
7. HABITUATION
So, once we understand the muscular process involved and what we visualize our child has to do to pee and hold it, we have assessed and strengthened the muscle tone we need so that our muscle group plays in our favor in this process, visualizing that the moment has to be relaxing and pleasurable, and we have some indicator that it is the moment... It's time to start getting used to sitting on the toilet.!
The process follows the lines, taking into account the fact that the child is sitting comfortably, with a stool for his feet, with an adapter that reduces the hole so that he does not have to hold on and put pressure with his little arms, which will not help us with that moment of relaxation, on the contrary. The strain of not falling down the toilet and having to hold on the whole time can make the process difficult.
The first step in habituation will simply be "let's go to the bathroom" as a receptive instruction. We take our child by the hand and lead him to the bathroom. We can open the lid, we can sit him down even while he's dressed, and try to get him to sit for a few seconds in a relaxed and controlled manner.
This first step will be the first contact, where we will tell the child specifically “let's go to the bathroom”, When dealing with non-verbal children and those with communication deficits, we have to understand that they are very literal in learning., so All our verbal communication has to be very preciseThat's why we say "let's go to the bathroom" and don't say "let's go pee" until we can visualize peeing, until we get them to do their first pees and be able to make the connection and visually and experimentally understand what peeing is. This is a very important aspect to keep in mind and will help us be much more effective in learning.
8. ROUTINE
You know that all the visual aids help them memorize the process and keep it in mind, so I advise you to have the sequence of photographs that help them have the process clear, What will that process be?
- Let's go to the bathroom.
- Take off my pants.
- Pull down my underwear.
- Sit on the toilet.
- Once you have peed, take a paper towel or wipe and clean yourself..
- Pull up your underwear.
- Pull up the clothes.
- Flush the toilet.
- Wash your hands.
- Remember to have a different panel in the mirror or sink with each step to wash your hands:
- 1st.- open the tap,
- 2nd.- apply soap,
- 3rd.- soap your hands,
- 4th.- put your hands under water,
- 5th.- close the tap,
- 6th.- Dry your hands with the towel.
Step-by-step process! IMPORTANT: We are going to teach you an extensive process, but it is very important that our children learn the process step by step until they are able to develop it completely. That is, if our child gradually integrates all the habits that we have repeated and that I have just explained to you but we cannot get them to pee, we will stop the learning process at that point, because our children with autism and communication difficulties tend to be very literal and close the circle and the process, and they can learn that the bathroom process is the entire process I have told you about except peeing, which is what really interests us. So it is very important to stop at the skill we are working on. This means that we will go little by little in each step, but if there is no pee, we will not flush the toilet. If there is no pee, we will not wash our hands and we will not follow the chain of events that follow.
This means that in this first step, our children may be rigid, thinking that they are going to the bathroom to take a shower, that they are going to the bathroom to wash their hands, and they have to learn a new routine, a new activity. For this to be successful, we have to do it step by step, first exposing them to this habituation of the toilet, of sitting, of these new elements that they are going to have to know and become familiar with.
9. CHANGING DIAPER IN THE BATHROOM
Once we have completed this habituation, we will incorporate, each at their own pace, measuring each of the phases for your specific child, We will incorporate diaper changing into the bathroom area, once we have prepared and overcome this habituation process in which the child already knows the directive, we go to the toilet, he already lifts the lid, he is already calm, he even sits down even with clothes and is able to wait about three seconds without stress let's start adding one more task, that will bring us closer to that future pee in the toilet.
Once we have put the child on the stool, we will proceed to remove the diaper and sit him on the toilet, this time without clothes. It is very important that in this phase we begin to mark the beginning and end of those waiting times while sitting, we will begin to count with numbers, with songs... a finite timeWe didn't come to the bathroom to leave him there forever or until he protests. So we'll start giving him time that he can assimilate according to his abilities, gradually lengthening it, either by adding more numbers to the count or going a little slower. This way, we'll slowly and calmly get our child into the habit of going to the bathroom. If the child doesn't pee, we'll pick him up, put his diaper on, and leave the bathroom.
It is also not advisable to teach the child to throw the dirty diaper in the trash, or to throw the poop from the diaper in the toilet... for the same reason that this more rigid learning helps us and distances us from removing the diaper, sometimes children tend to cling to the diaper a lot as comfort and tend to be rigid when it comes to leaving certain habits, so try not to teach them to throw the diaper in the trash or intermediate steps that can generate behavior.
10. SCHEDULES
All our planning has a meaning and we will start doing it in a routinely, When we get up we generally go to pee, before we go out we generally go to pee, when we come back from the street or before going to sleep…We will incorporate logical routines that will help us, punctually, establish a logic in that habit, every three hours but not every 15 minutes.
It is also important to take into account the physiological and organic behavior of our children, both in peeing and pooping, recording the moments when they poop regularly, the moments when they drink more water and pee more. This will help us to set more appropriate schedules and be successful much sooner than if we do not have this data that tells us what organic style of peeing and pooping our child has, so losing or gaining time by recording that behavior for a few weeks.
11. AID
Once we have a more detailed understanding of the process, we'll try to help those children who can't pee in the toilet. We'll go into more detail. the aids we have to do in parallel to reinforce understanding of the dynamics and everything that it entails: the space, the objects, the moments, the actions…
And on the other hand, I will give some effective aids to find that specific moment, such as being able to provoke, above all, the moment of peeing in order to have that experimental moment and be able to be graphic in learning with something real.
Prior to and in parallel to this work to strengthen awareness of what is happening we can provide in these situations diapers that don't absorb as much (cloth ones are ideal) where the little one can feel the humidity, and besides being more aware on a sensory level, may even decide that it is necessary to change because he is uncomfortable. It also helps in this process to put on clothes that are easy to put on and take off (pants with elastic at the top, avoid jeans, pants with buttons, bodysuits and overalls that are difficult for the child to remove. In this process, it is recommended that the little ones wear comfortable clothing that is easy to put on and take off. The diapers-panties They are very convenient when you start to leave the diaper. In addition, as in any learning process, it is important to be constant in routines and know how to wait for foster their autonomy.
If we want to prepare him, we can use everything from directed play to stories to show him how the toilet works and what we expect him to do in it.All of this must be done ahead of time, nothing like running for two weeks beforehand; it's about going at your own pace, not imposing an unnatural rhythm.
12. HELP AT THE MOMENT…
Glass of water.
You will be well aware that when we put our children in the shower to bathe them, they generally tend to pee, and they do so for two main reasons: the change in temperature, contact with the water... So we can use a small glass of warm or hot water and pour it over their belly button to facilitate and provoke that pee coming out.
Relaxation exercises.
Another aid we can suggest is doing relaxation exercises on the toilet, using a feather, a few gentle tickles, singing a song... Here I'd like to clarify several things. Many of you ask what happens if we can use tablets at these times. The most important thing is not to lose sight of the purpose of this moment, which is relaxation. So if the child can relax, be calmer, and better endure the moment through the tablet, there's no problem introducing it at this time. It can even help them wait and relieve tension, like many people tend to read or look at their cell phone while on the toilet.
So far we have finished the first article related to the big step of leaving the diapers and starting to get into the routine of going to the bathroom of our child. nonverbal children.
In a few days, you will have the second part.