Tuesday, June 12, 2018

Special Needs Potty Training . . . Take Two . . . Eight Months In

Well here we are, eight months in with potty training round two, and since it's been a while since my last update, I thought I would catch everyone up on where we are overall in the process. 

I last shared in this Instagram post that Clara met her goal of one month with no (pee) accidents! This was an gigantic win for Clara and our family. We are so proud of our girl. She had been on this step of the protocol since December 2017, so again, huge accomplishment.

Since the end of March we have been training her (both at school and at home) to use her AAC device to tell us when she needs to use the restroom. What does this look like you might ask?

Clara initiates using the restroom by walking to the restroom and waiting for me to come help her pull down pants, get on the toilet, etc. Now that we are training her to use her AAC to initiate potty (instead of just walking and standing there), we keep her device on the bathroom counter.



When she walks into the restroom and waits by the toilet, we use a total physical prompt to show her the button to push that then speaks out loud "I need to go potty please."

The goal in this, and just like anything we are teaching her, is to use the least prompting as possible. We start with a full physical prompt (my hand over her hand pushing the button with her) and once she masters this we move to a partial physical (touching her wrist or elbow to  signal to her to push the button), and then to a gesture (me pointing to the button to remind her, but not touching her) etc.

Currently, when she gets to toilet all I now have to do is give her the verbal prompt, "Tell me what you need," and she presses the correct button!

Once she is consistently able to use the AAC next to the toilet with no prompting (not even verbal), we will then stop her by the bathroom door and prompt her to use her device. Once that location is mastered, we will stop her in the hallway, and continue to increase the distance from the restroom until she is using her device regardless of where she is in the house. The hope is that this concept will then translate when out and about in the community so that she knows regardless of where she is, she can push this button to tell us, or other adults, that she needs to use the restroom.

She has come so far in eight months. I know she will get this, too. I am beyond thankful that most of the urine is making it into the toilet, even if we are still homebound quite a bit.

Caught this big smile right after I picked her up from school! 


Since I'm sure you all are dying to know where we are with bowel movement training, I will break it down for you.

She would rather poop in her underwear.

The end.

Y'all. I don't sit around and whine about all the extra behind the scenes work that goes into parenting a child with disabilities, because really, what good is that going to do me? (Not that I don't ever want to. I'll admit that.) But can I just have a moment? I have cleaned so much poop over the last eight months I could just cry a million tears. Poop in my fingernails. Poop on the floor. Poop on my feet. Poop on Clara's feet. Poop on my legs. Poop on Clara's legs.

Everywhere.

Somewhere along the way I texted Brandon something along the lines of "Omgosh. I cannot handle the poop. I just tossed three pairs of underwear because I. Just. Can't. Scrub. One. More. Pair. Nope. Ain't happening."

Except I didn't use the word poop.

Also, it is important to note, she has only had one poop accident at school since we started eight months ago. I'm on to you, Clara. I see what you're doing here.

ANYWAYS.

In an effort to turn this train around, we've been collecting data the past few weeks of all things poop. So glamorous, right?


We've been recording . . .

Date
Exact time
Location of accident
What she was wearing
Consistency of the poop

I realize this is 2018 and there is probably an App that could make this easier, but instead I created a chart on spiral notebook paper that looks like it was crafted by an 11 year old, instead of a 35 year old.

You can pin this if you want.


After several weeks of charting, next steps include . . .

  • Close off all bedroom doors (since that seems to be her poop location of choice). 
  • Schedule a 20 minute sit at 6:10pm to try and catch a success on the toilet. 
  • Play Ipad will be faded as a reinforcer for pee success and will only be given to reinforce a successful bowel movement. (No time limit)
The silver lining to a 20 minute sit? She thinks my iPhone timer is funny. Love these giggles!


She has come so far in eight months and I know she will keep making strides toward mastering this developmental milestone.

*** UPDATE*** After my meeting this week with Clara's BCBA we are tweaking the protocol a bit. Not that anyone cares, ha-ha, but this is more for my records than anything. Because let's face it, in a few years I will not be able to recall any of these details. Anyways, still closing bedroom doors. Still a scheduled sit at 6:10pm. Still only giving the iPad for a successful poop in the toilet and a less preferred reinforcer for pee. We will now have her wear her AAC device 24/7 to help encourage her to use it to initiate potty and other things. But since she tends to stim on it (hits buttons repeatedly, at random, thus not using it functionally) we are incorporating a bluetooth system. Clara will wear the AA 24/7, but only I can hear noise from the buttons. This will hopefully reduce the satisfaction she gets from stemming (since she won't hear anything). When she uses it functionally, I reinforce as needed, but when she stems, I walk in and remind her to stop. So now I get to wear wireless headphones around the house from 3:30pm - bedtime. Yay! :) We will also be keeping the bathroom door closed in order to help facilitate use of the AAC. Here we go! 
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