Potty Training and the Sensory-Defensive Preschooler

October 5, 2012 by in Autism, Potty Training, SPD with 12 Comments

This post isn’t for the faint of heart.  Two words – two little words – that can strike fear into the hearts of every special needs parent.  It rocks our worlds, forces our children to confront challenges, and causes enough headaches that buying ibuprofen in bulk seems like a good plan.

I’m talking of course about potty training.

My boy is 3.5 years old.  He has a multitude of special needs, but the ones that seem most applicable to the potty training dilemma are his autism, his hypotonia, and – of course – his SPD.  So, what do you get when you put a kid with communication challenges, sensory issues, and low-tone together with a potty?  A whole lot of nothing happening, that’s what.  Or, at least that’s what’s happening (or not happening) in our house.

There was a point long before we had any diagnoses for Jack – he was about 18 months old – when he suddenly started peeing every evening in the bathtub.  We made a big deal about it, pointing it out, trying to give words to what was happening.  He was non-verbal (we were still in our “denial period, so we didn’t want to admit that anything was wrong), but we thought that if we just made going potty part of the bath-time routine, maybe we could start down the potty training road.  So, we tried to sit him on the potty, supported of course.

He hated it.  We’re talking full-on, screaming, flailing, crazy man hated it.  We didn’t know anything about sensory issues at the time.  We just figured he wasn’t ready.

Come Jack’s 2nd birthday and his autism diagnosis, plus others.  He was testing at the level of a 7-month old at that time, so potty training was low on our priority list.  It was far more important that he learn to eat without vomiting, talk, and simply be able to have some awareness of his surroundings without having a meltdown.  As the year went on and we were on the way with therapies and services, we never forgot that potty training.  It was hard to forget when friends were posting on Facebook about their potty training successes (“M has gone 3 days without an accident…yay!”) and I was bragging about other successes (“Jack hasn’t thrown up in 48 hours!  A record!”).

As the year went on and our knowledge of sensory issues grew, we accumulated just about every toileting apparatus that they make for the fledgling toddler/preschooler.  We bought potty seats (with Thomas the Tank Engine no less, complete with matching stool!) all the way to stand-alone potty chairs with lovely plush seats (none of the hard plastic pee guards).  We weren’t going for going potty on the potty yet; we would be happy with him sitting on it without having to hold him down kicking and screaming.  We’d try every now and again and – having a bad reaction each time – would back off so that we did not turn the toilet into an object of fear.

We even considered letting him pee standing up like a “big boy”.  I know, all the moms out there are cringing at the thought (and the mess), but we were desperate for finding something that worked.  Unfortunately, as we were soon to find out, Jack had almost no awareness of what was going on with his body when he went to the bathroom.  Unfortunately, this made even peeing standing up a challenge.

This scenario has played out at various times in the past two years.  Honestly, toileting still hasn’t been super high on our priority list, but it’s getting higher on the lists of others.  Jack’s medical team and several of his therapists don’t seem to be concerned that potty training hasn’t really gotten off to any real start at all; in the words of Jack’s doctor, there are simply “bigger fish to fry at this time”.  However, I’m starting to get some pressure from some people to really get tough about it.  I can hear their chiding now…

You don’t want to be changing the diapers of a 4-year old.  He’s one of only 2 in his class that isn’t potty trained.

It’s starting to drive me nuts.  I want to scream “Do you think I enjoy changing diapers?  Believe me, I know how gross it is!”

Here’s the thing – we are trying.  We are seriously trying.  We are just trying to get him comfortable with sitting on a toilet for even 3 seconds.  We haven’t achieved that yet.  We’re trying to help him gain some awareness of when he needs a diaper change.  He’s unaware of when he’s peed, and not always aware of BMs.  He has an IEP goal right now of being able to request a diaper change – in any communication mode he chooses – when he needs one, but he’s not doing that, either.  I’ve picked him up from school several times lately to find that he has been wearing a soiled diaper.

Right now, he’s testing in the 18-20 month range in most areas of development.  I want to scream to people “Would you expect a 18-20 month old to be potty trained, yet?”  No, you wouldn’t.  So, just because he’s in a 3.5 year old body doesn’t mean that he’s ready.

It certainly doesn’t mean that I need to get pressured.  As a special needs parent, it’s hard enough cramming your day full of feeding, oral-motor, social/engagement, fine/gross motor, and communication – never ending communication – activities, plus a full sensory diet.  Hearing from others that there is just one more thing that he “should” have accomplished by this point is really more than I can take some days.

I’ve had to acknowledge that no amount of pressure or goal-setting will make Jack accomplish anything any faster.  He’ll do it in his own time, and that may have to be enough for now.

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About ReinventingMommy

Jeanie is a former engineer turned stay-at-home wife and mom to an amazing 3-year old little boy on the autism spectrum. After her only child was diagnosed at 24-months with autism and an alphabet soup of special needs, she began to write about life parenting a very young child with special needs with honesty and, as always, a touch of humor. When not posting here, you can find Jeanie at her blog, Reinventing Mommy (http://reinventingmommy.blogspot.com/).

    Comments

  • Karen


    I have a 4 year old with no diagnosis other then speech apraxia (unofficially). We are going for a PT eval on Wednesday. He’s a very happy, calm kid. But he’s 4 and appears to have no knowledge of his potty needs. He loves to sit on the potty…but that’s it. Nothing ever happens. I obviously need to pursue this…but with him being so happy, and my older son having such aggression issues and getting him started with all sorts of stuff, this child just kind of got put on the back burner….I always feel bad for my babysitter because his BMs are very nasty! (Wouldn’t be surprised if we have some allergy issues as well.) My goal was to start working on Monday…but instead he ended up so sick we were admitted to the hospital….maybe next week…or the next….

  • momofamazing7yrold


    Don’t feel bad. My son is 7 this month and I am still changing his diapers, he still has little recognition of his bodily functions and we let him tell us when hes ready. We have the potty seat in the bathroom, he sits on it when he wants and sometimes we go a week with him using it for pee, but then he regresses again. I would force the issue more if I wasn’t secure in the knowledge that he has very little control over his bladder or whats happening. I am much more happy to celebrate the gains in his education, socialization and sensory avoiding.

  • Jill Q.


    You are not alone. I struggled off and one with this all summer w/my guy home from school (he’s 3.5 too). I feel like my son kind of, sort of gets it some time. On an intellectual level, I believe that he will get to be potty-trained someday. I know he has that potential. But on an emotional level, it is hard to believe it will ever happen when we’ve struggled so long with it.
    This struggle was actually what got me reading “autism parent” memoirs and blogs b/c I felt like if I could read about other parents who got through it, it would give me more hope.

    No one is more motivated to get their kids potty-trained than the parents :-) , no matter what people on the outside might think. Our kiddos do stuff when they are ready and sometimes that time table can be frustrating for the rest of us, but that is how it goes.
    Best of luck!

  • ReinventingMommy


    Thanks everyone! This is why I love this community – there is always someone who is in the same place that we are, or who has been there before, and just gets it.

  • EHCMom


    I feel for you and understand your concerns and the “pressure” you get from others. My daughter is 5 y.o. and is still not fully potty trained. We’ve tried every method with short-term success, then always a regression. We recently started a behavioral management method used for ADHD kids (recommended by our OT), and have had a longer period of success than previous methods. The biggest frustration is the fluctuating success. Three days staying dry, then the next day wetting all day. It can make us feel insane sometimes. We want so badly to find the key to unlock the reason for this, but it always seems to evade us. The only thing I feel comfortable claiming at this point, after two years of attempts, is it’s connected to the interoceptive sense. I’ve read some promising studies about therapeutic listening and interactive metronome therapy helping with this sense. We found the listening therapy did help–many more successful days than usual, but the OT recently found out they were violating their licensing agreement by letting us take it home, and they took it back. Now she’s in a period of regression. The interactive metronome therapy is not covered by insurance, so we haven’t pursued it yet.
    Be prepared for a long haul. It indeed is not for the faint of heart to potty train a child with SPD, autism, and the like.
    My one recommendation is to get him out of disposable diapers right away. Kids with autism and SPD have a difficult time sensing wetness, and they completely lose that ability if they’re in disposable diapers long term.
    I’ve read about six potty training books, as well as blogs and articles, and I’ve found the best book about potty training is Toilet Training for Individuals with Autism or Other Developmental Issues, 2nd Edition by Maria Wheeler, Carol Stock Kranowitz M.A

    • ReinventingMommy


      Thanks for the book recommendation! I’ll definitely have to check that out!

  • Marcy


    My son, with Aspergers, is now ten. We tried potty training him for 2 full years (actually longer but who cares after 2 LONG years?) In the end, I had the most awesome teacher tell me that she could toilet train my son. She owned a private company that did things for special needs kids (a potpurri of things)like toilet training. She and my son’s TA, who also worked for this private company, came and took two days to TT my son. He still did not go #2 but during the process they helped him recognize his signs. It was intensive and it was AWESOME!! I have never heard of anyone having this done for their child, but then, I don’t have a lot of people (small town) in my life who has special kids with SPD (etc).

    My son was FOUR when this happened. Two weeks after this my prayer was answered and he did #2 in the toilet.

    The pressure from “regular” parents or grandparents (don’t get me started)is astounding. I had several say “If I had him at my house for a week I would have him potty trained in a day.” Whatever. Go for it. Should have taken that one up. LOL!

    Give yourself a break and know that you are doing a great job. Give him time. See what is out there for a resource like what I had. I have no idea if there is a “program” like that anywhere else in the world. I was “lucky”

  • naplesmama


    Our daughter (now 12 yrs.) trained easily for urination but, struggled mightily with bowel withholding until the age of four. Although not formerly diagnosed, she exhibited many of the behaviors associated with Sensory Processing Disorder. Potty training for BM(s) dictated our lives…despite endless Google searches and countless calls to our pediatrician, none of the recommendations produced the desired results. Adding to the frustration was the lack of printed material for children dealing with this particular challenge. Seven years (and many rejection letters) later, I decided to turn our family’s experience into a book and self-published “I Can’t, I Won’t, No Way!” A Book for Children Who Refuse to Poop (available on Amazon.com). To date, it remains one of the only potty training books of its kind…written entirely from a child’s perspective. Bright illustrations and rhyming verse were carefully selected to appeal to all little ones…including those with special needs. I can’t promise it will solve the problem but, it can assist in breaking down resistance and serves as a reminder to parents that they are not alone!

    • EHCMom


      Is your book exclusive to bowel toileting problems or do you think it may be helpful for my daughter who has wetting problems?

  • Heather Finnegan


    My now 7 year old finally figured out how to pee in the potty at age 4 because he wanted to go to school. He FINALLY started to poop in the toilet at age 5. And even then wasn’t with the greatest success. This summer we had to visit a pediatric gastro to deal with my son’s stool holding. We are now on a regimen of miralax and sitting on the toilet for 10 minutes twice a day.

    And he HATED sitting on the potty, both kid ones and the regular toilet. He still sits to this day at age 7, and my 4 year old stands to pee.

    • EHCMom


      I recently read about an interesting toilet “accessory” called a Squatty Potty. It’s recommended for anyone who has to sit a long time in order to get a bowel movement out. I haven’t tried it, but the science behind it is interesting.

  • EHCMom


    I’m reviving this thread just to update those who are interested. We discovered our daughter is sensitive to acids (citric, ascorbic, sorbic) that were causing bladder spasms, which were preventing her from holding the urine in when the spasm hit. Since we have eliminated these acids from her diet, other than occasional dribbles because the muscles still need to get stronger, she is fully potty trained. A urologist told us two years ago that Vitamin C could cause bladder spasms, but I never fully thought it through to make the connection to all the foods in her diet. If you read labels, citric acid (Vit C) is in nearly everything–bread products, beverages, pretzels, prepared foods, medications, skin care products, etc., etc. It has been a challenge to eliminate it from her diet, and I have to make sure she gets enough Vit C from veggies, but it’s great to have finally discovered why potty training was such a roller coaster experience, to know it wasn’t anything we did or failed to do, and it wasn’t because of her behavior. Victory!

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