Special Needs Potty Training . . . Take Two . . . Two Years In

Hi. My name is Brittnie and I have a blog. Apparently 2019 got busy and I forgot how to post in long-form. Well, that's not true, but Instagram makes it so easy to post quick, mini-blog thoughts and so the idea of uploading a huge post here in-between toilet training sessions made my head spin out a bit. And now it's December.

Speaking of potty training. . .

We are officially two years in.

I am still cleaning poop out of underwear.

The. End.

GOOD THING SHE'S SO CUTE 

. . .

Here is where I left you back in March of this year, when we were 16 months in.

I wish I had more of an update, but alas, there is none.

It's a two step forward, 10 step back kind of dance so to speak. She still has no access to her light-up toys until she successfully goes on the toilet. But, she seems to prefer her pants over the commode. Yay! She has one-two successes a week, and that is usually from one of us catching her in the act and running her to the toilet. This obviously requires eyes on her most of the time in order to catch the signs, which is, um, doable for a while but challenging long-term because #reallife.

I literally took this picture this morning after arising to the nice smell of my child's soiled room/pajamas. Praise the Lord for pull-ups (night = only time she wears one) and dance leotards.
Yes, the mask is upside down. Don't even care. It's a matter of get it on and get the job done. 

There may or may not have been one incident where I said, "Clara. First poop on potty, then light-up toys.' To which she replied by pulling my hand all the way from her room to the restroom and promptly pooping on the toilet. Ahem.

There may or may not have been another incident where she came walking out of her room with no clothes on. As in, completely naked from the waist down. I walked in her room to find her pants and underwear, completely clean, on one side of the room, and a pile of poop on the other side of her room. Clean underwear on the right. Pile of poop on the left. Okay then. (Jokes on you, Clara, because no longer are we helping you pull down your pants when needed, hahahaha.). 

PLEASE DO NOT BE FOOLED. SHE KNOWS WHAT SHE IS DOING.

My hopes and dreams for 2020?

Less Fabreeze. More Leap Frog Light-Up Dog on repeat. :)

(In all seriousness, thank you for all the love and prayers, friends! We appreciate you all so much!)

Special Needs Potty Training . . . Take Two . . . 16 Months In

We've made it 16 months in our second go-round of potty training!

The day we took away Clara's pull-ups feels like an eternity ago. The last 16 months have felt long and hard, but like a lot of things, worth the work.

Click here to read the one year in update. 

When we left off at the one year mark, we had just finding collecting data on her bowel movement habits (lovely, right?), and had experimented with isolating ourselves to the restroom for three hours in the evenings in hopes to catch a a BM success, which proved ineffective.

Finally, on January 21, 2019, we pulled out the big guns.

I posted about it on Instagram here. Recap below in italics.

Well, today is the day. I’ve been avoiding this like the plague but after 14 months of cleaning up poopy pants I figure maybe I should take the advice of Clara’s BCBA and just do it.

See all these toys? Yeah. All of Clara’s favs. And they will disappear by the time she returns from school. 

Once she successfully poops in the potty she will have access to all of them for the remainder of the day. Then they disappear again until the next success. Repeat daily. Omgosh.

She is a cute but she is stubborn (14 months and she’s only had one poop success and ONE POOP ACCIDENT AT SCHOOL. Meaning, she doesn't poop in the toilet at school nor does she poop in her pants at school). She just loves saving it all for mommy and daddy. We feel so special. :-)

It’s not everyday someone asks you to pray for their child’s pooping habits, but if you feel so inclined ... 🙏🙏🙏. Day one! Here we go! #specialneeds #cohensyndrome#operationpoopgoesinthepotty

We are now a little over a month into this method of positive reinforcement, and while it isn't moving as fast as I would like, we are seeing slow signs of progress. The hard part is having eyes on her 24/7 to catch her signs of needing to have a BM. Additionally, if I miss the signs and she goes in her pants (which she likes to do the minute I leave her room/presence), it might be several days until the next BM, which lessens the opportunities to pair the behavior (poop in potty) with the reinforcers (light-up, musical toys). 

Camille is the BEST cheerleader around. 

So while it feels S-L-O-W and some days I want to poke my eyes out, I can't deny the success she has had over the last six weeks. She's pooped in the potty at school three times and three-four times at home. The excitement on her face when the toys come out (the second any poop hits the toilet water) is beyond precious! 

Not pictured, ALL THE TOYS ON HER BED. 

Slow and steady wins the race, right? Easier said than done, but that is what we are clinging to during this season on life. Put in the work now and eventually it will pay off. So we press on.

Praying that in four more months, at the next blog update, we have much continued success to report! 

This girl. Just can't get enough of her!

ALSO, here's a little laugh for you in case you need one on this Tuesday. Last week I was in that crazy hour of day called witching hour (yes, it is still a thing when your kids are 5 and 6), so I left Clara in her room to finish dinner prep. Brandon walks in the door five minutes later (mistake numero uno, left Clara in her room unattended for five minutes) so I ask him, "Hey, once you get changed can you go check on Clara?"

Several minutes later he's all, "Ummmmmm Britt. What is going on? Did you forget to come back and clean up all this poop on the floor?" And I'm all, "I know I am losing my mind and forget a lot of things, BUT DO YOU REALLY THINK I WOULD JUST WALK AWAY AND LEAVE POOP IN HER ROOM?" I turn the corner and he is standing there, dumbfounded, with Clara's pants, poop-streaked-underwear, and poop in his hands. 

Guys. 

She pooped her pants once I left her room and THEN SHE TOOK HER PANTS AND UNDERWEAR OFF ON HER OWN. 

There she stood, leaning over her bed, naked from waist down, playing happily with her favorite fidget toys. 

I can't even, you guys. 

So while this whole situation was gross (#understatement) and obviously not ideal, can we all just stop and cheer that this kid 1. is starting to recognize poop is gross and shouldn't stay in her pants and 2. knows how to pull off her pants!

That is all. 

Happy Tuesday! 

Special Needs Potty Training . . . Take Two . . . One Year In

Y'all. We have officially made it to the one year mark of potty training Clara (our second attempt) and We. Have. Come. So. Far. I read back over the beginning days and almost broke out in hives.

Below is how we started a year ago . . . 

• Every two minutes prompt to drink.
• Every five minutes conduct a dry check. If dry give verbal praise.
• Every thirty minutes - 10 minutes on the potty, 20 minutes off.

Needless to say, this year has simultaneously flown by and creeped by and we have spent a lot of time in the restroom, a lot of time cleaning up messes, and a lot of time cheering our girl on because she is stinking amazing!

For a refresher on the nitty gritty protocol details, click to read our 4 month update and our 8 month update.

The protocol we've been following, with the guidance of Clara's BCBA, is no joke. Talk about intense. But it is working, friends, and I can say it has been worth the work (as is most hard things).

Clara is so much farther along at this one year mark than I ever expected. She is urinating consistently on the potty and initiating at that! She initiates by walking to the restroom and waiting for us (so we still have to continually check her location in the house) or by taking our hands and pulling us in the way of the restroom. She rarely uses her AAC device to request potty (working on it!), but she is good about holding it until we give her the opportunity to go. When we are out in the community we offer her the opportunity to go every so often since she doesn't necessarily know where a restroom is located (and thus harder to initiate).

Now we just need sweet girl to poop on the potty. Mama is ready for this milestone. Ahem. She still prefers her underwear and all my pep talks about why it's super fun to poop in the potty and not our pants aren't sticking yet. :)

But she knows how to do it.

We traveled to CT for an entire week in October and I only scrubbed poop out of her underwear one time. ONE TIME! She initiated and successfully pooped on the potty 4-5 times, ohmygosh. We were amazed! And so thankful! What a gift, especially while on vacation!

Joke was on us, though, because the day we got back home she pooped her pants. And continues to do so . . . So basically she is playing us hard. You're not tricking us, Clara. :)

So where are we now, one year in?  . . . 

• Continue to prompt her to use her AAC device to request potty when she initiates. When she drags us to the restroom, remind her to tell us by pushing her potty button. This has taken some trail and error over the last few months. We've experimented with her wearing her AAC 24/7 (but then she continuously chews the shoulder strap) and also leaving it out on the kitchen table (but then I'm always running to get it) or even leaving in the restroom (but then she forgets to use it for other things like requesting food/ toys etc). 

• After a period of time of collecting data on her bowel movements and making adjustments accordingly, and after a recent two-week period of isolating ourselves to the restroom from 4:00-7:00p.m.* (after we discovered she could do it in CT and in an attempt to remind her that THE RESTROOM IS THE ONLY PLACE WE POOP), we are at a bit of a loss in how to encourage her in this area. Her BCBA is consulting the behavioral committee to see what other suggestions they have.** Any behavior specialists out there with any input or recommendations? I'm all ears!
• Keep encouraging our girl and raising the bar and working hard expecting that in time, she WILL be fully potty trained. 

Thank you for your support and encouragement over the last year. We are so thankful for our family, friends, and overall community that stands with us as we tackle these extra hard milestones that come with raising a child with special needs. Prayerfully, Clara will be consistently pooping on the potty at my next update four months from now. 

Love this beautiful child! 

*No, not a typo. That's three hours in the restroom. Okay, so how did that work? Clara didn't have to sit on the toilet that entire time. But we did have to stay in the restroom that entire time. Since our data showed Clara typically only poops once a day, if she soiled her pants or had a success we could leave the restroom and go on with our evening, or if she soiled her pants or had a success earlier in the day we did not have to complete the three hour bathroom stay. Not having to stay in the restroom + unlimited IPad time was the reinfocer used for increasing the desired behavior. 

**Updated 11/20/18 per Clara's BCBA - Starting the Monday after Thanksgiving, 11/26/18, we will restrict her access to ALL light up/musical toys (HER FAVS!). As in, she gets zero minutes with any toy that lights up or plays music until she has a bowel movement on the potty. Once successful, she can have access to those favorite toys for the reminder of the day. AHHH. In the words of another behavior specialist, "This will be effective but the process will be hell." HERE WE GO! (Also, we no longer are to reinforce her at all for peeing on the potty as that is now a mastered skill.)

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! 

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

Some of you know we started potty training Clara at the end of October of 2017. This is the second go-round with potty training. 

Love her smile here!

#justholdme

Our first attempt started okay, yet ended with us never fully taking away her pull-ups, which resulted in us slacking on her sit schedule, which basically confused the daylights out of Clara, which is not ideal for a child who is significantly delayed in development. Consistency is um, key. I could fill these lines with lots of excuses as to why we never fully went for it (language barrier being the main excuse) but honestly, I just wasn't ready to go all in and give it 100%. 

Toward the end of last year Clara's BCBA (Board Certified Behavior Analyst, think lead therapist that is in charge of her targets and treatment plan at school) encouraged us to try again and this time go all in. As in, follow their protocol 100%. As in, take away the pull-up from day one and no going back. Our BCBA thought she was ready and since it was the start of "a new school year," (she goes year round but this decision came in the fall of the school year) he encouraged us to truly give it our all. 

I am not exaggerating when I say I cried for a solid 24 hours leading up to day one. Brandon thought his wife had gone off the deep end. Bless his heart for not giving up on me. 

Initially the protocol was intense (see below). And by intense I mean we were literally living in the restroom. This protocol was happening 24/7 (unless sleeping at night), both at school and at home. 

• Every two minutes prompt to drink.
• Every five minutes conduct a dry check. If dry give verbal praise.
• Every thirty minutes - 10 minutes on the potty, 20 minutes off
• Play iPad is reserved for successful voids on the toilet only. If she has a success she gets the iPad for 5 minutes, then it goes away. She is not allowed access to the iPad at all unless a success. This will help pair her most reinforcing item with voiding on the potty. I pee on the potty, I get iPad.
• If she has an accident, we say "No wet pants," and take her immediately/swiftly to the toilet to sit and help clean herself up.

Those first few weeks were messy to say the least. Like REALLY messy. Yet, approximately two weeks in, she started initiating! I was honestly shocked she picked it up so quickly. Once she started initiating, we were told to drop the sit schedule (all the praise hands!), yet still prompt her to drink every two minutes and dry check her every five minutes. 

Once she achieved 20 straight successes with no accidents, (only referencing urine here, was told BM's will come later, so when I reference an accident I'm referencing pee) we stopped pushing fluids. She conquered this in December 2017.  

The next goal, and where we have been since December of last year, is one month of initiations with no accidents. Once she makes it one month accident free, we can teach her to mand/request for restroom using her iPad/speech device (she has a separate iPad for communication).

Our BCBA is confident in this requirement/goal of one month accident free, and it is based in the latest ABA (applied behavioral analysis, the type of therapy Clara receives at school) research for children who are delayed in development/Autistic. 

The longest she has made it is three weeks accident free. Again, just talking pee here, she still poops her pants daily (smile). I keep reminding myself that three weeks is remarkable! Truly incredible! But honestly, it is disappointing and frustrating when you think you're almost there and then boom, accident. Data is wiped clean and you start over, again. 

Lately, we have seen regression on the weekends, for whatever reason. We are investigating this to see what triggers might be occurring and how to help eliminate them. The past few weeks she has had accidents during the week, as well. Two last night. Sigh. I know she will get there. I know she will. 

We have been limiting her outings because 1. she is required to initiate and 2. she does so by walking to the restroom and 3. we are this far in and thus determined to not deviate from the protocol. So as you can imagine, asking her to initiate when out and about in the community can get tricky when she doesn't know where the restroom is located. So we are homebound a lot. Which is okay. I know this is just a phase and it WILL be worth it in the end. Just got to keep pressing in and pressing on. 

Once we can teach her to request restroom on her iPad, her world (and ours!) will really open up again and we can do more things as a family of four etc. 

Thank you for the encouragement, texts, phone calls and random check-ins over the past few months. We feel loved and supported and are beyond grateful for those that rally around us in times like this where raising a child with special needs feels a bit, well, tiring. 

Loving her new glasses!

(Eyes must be on her all the times, as we have to see when she walks into the restroom. This can be challenging when multiple children have conflicting needs both physical and emotional. We have tried putting a sensor in the restroom to alert us when it senses motion, but every one we've tried is WAY too loud and scares the daylights out of her.) 

Will you pray with us that God will open our eyes to any triggers that might be causing the regression? Will you pray that we won't grow weary in his process and will continue to give it our best? Will you pray that Clara makes it one month accident free?

Thank you, thank you, thank you! 

Praying the next update involves Clara requesting potty on her iPad/speech device!

***There's been a few times I/we have missed Clara walking into the restroom and found her minutes later on the toilet just sitting there waiting for us. Cutest ever! A few times her pants have been drenched, but we were so proud because she did what she was supposed to do! She felt the urge,  held it, walked to the restroom, got on the toilet, and urinated. She can't pull her pants/underwear down unassisted, thus why she was soaked. Once she did the same thing and then even got off (guess we were really distracted, usually happens around dinnertime) and flushed the toilet! We ran in to find her grinning from ear to ear!! Her pants were soaked but man, what a gift from God to get this glimpse into what she CAN do and the confirmation to just keep at it.***