Tuesday 25 February 2020

Let's Talk About ...... Toilet Training

**** Please note that the advice in this post is based on our personal experience in toilet training children. I do not receive commissions of any kind for any products mentioned in this post.****

Over the last few years on our Autism journey, I've been asked for advice on many different topics. One topic that comes up in conversation on a fairly regular basis, is "do you have any tips for toilet training my child?"

Well, where do I start?!?!?! Working in the early learning industry and toilet training both of my own children, I have used a number of different strategies to toilet train both little superheroes as well as children in my care at work. But let's face it, toilet training any child, regardless of diagnosis or not, can be daunting but toilet training a child who struggles to understand their internal body signals, interoception, can make toilet training that little bit harder.

Before we get into toilet training, I'll recap on interoception for those of you who haven't heard if it before now. Interoception is one of our hidden senses and it consists of all of the internal sensations that we feel on a daily basis - including when we need to go to the bathroom. For children on the spectrum, interoception can play a big factor in struggles with toilet training.

Children who have been diagnosed with Autism Spectrum disorder may struggle with toilet training for a myriad of reasons. Their sense of interoception may still be developing and even though their body is sending all the signals that they need to go to the bathroom, they may not be able to correctly interpret these signals. Children whose communication skills are still developing may not have the skills to verbally tell you that they need to go to the bathroom. They may also lack the motor skills - both fine and gross motor - to physically use the toilet.

So what tips can I pass onto you, the reader, on teaching your child, or perhaps a child in your care, to use the toilet?

First things first, the key to toilet training of any child is patience. Depending on the child's skill and developmental level, toilet training can take some time. Be patient and calm - children pick up on this in us. If we are patient and calm, then we can assist the child to be calm. Toilet training is a big skill for any child to learn. For some children, physically sitting on a toilet can be nerve wrecking.

You also need to ensure that your child is showing signs of being ready to toilet train. These could include -
  • Indicating to you that their nappy is wet or soiled - they may try to take the nappy off or they may vocalize or sign to you that their nappy is dirty.
  • Your child may physically take you to where the clean nappies are stored or they may go and get a clean nappy themselves.
  • Your child may be staying dry most nights while they are sleeping - this indicates that their bladder and bowel control is developing.
  • They take more of an interest in the toilet.
We began toilet training both little superheroes when they started to show signs of being ready. O was relatively easy to toilet train, but in saying that she was toilet trained at day care long before she was at home.

With O we used a book called "Stress Free Potty Training." At the beginning of the book, the reader does a quick questionnaire about the personality type their child and then based on the child's personality, the book is broken down into tips for each personality. When I initially read the section based on O's personality type (she was a child who would master a skill and then not do the skill again,) I said to my husband that the book could have been written specifically about O! We were then able to toilet train O very successfully and quite quickly.

With L, however, toilet training didn't come naturally to him and for a long time we really struggled. At times, L showed an interest in that he would sign to us that he needed to be changed or he'd simply take his own nappy off but we really struggled to toilet train him, and at other times he showed no interest at all.

It was really only after he started early intervention therapy and his therapists gave us some tips and tricks of the trade, that we were able to properly begin toilet training with L.

So what did we do? Well....

We had to build L's confidence up in using the toilet. To begin with we'd simply get L to sit on the toilet (with the lid down) fully clothed, just to get him to feel comfortable. We read stories about going to the toilet - one of his favourite books was a book with the Sesame Street characters in it. We'd read this book to L while he was sitting on the toilet. One of the reasons that I think L loved this book is that the final page was interactive - he was able to flush the toilet on the last page by pulling a lever down! We'd read the book and then he'd play with the last page over and over again!

We were made aware of the fact that L's sense of interoception was probably still developing which could account for him lacking the ability to tell us when he needed to go. Whenever either myself or Daddy Superhero needed to use the bathroom, we'd encourage L to try too. We'd let him know that "my tummy feels a bit sore, maybe I need to go to the toilet," in the hope that he would begin to recognise his internal feelings. L watched us many times when either of us went to the toilet!!

L's therapists at the early intervention centre created social stories for Lachlan about using the toilet. These were personalised with photos of Lachlan in the bathroom - flushing the toilet, sitting on the toilet and so on. We also had social stories about washing hands.

We put up visuals in the bathroom on the steps involved in going to the toilet and washing hands after using the toilet. We still use these visuals just as a reminder of the steps involved as occasionally L still forgets the steps. It's not a case of L being lazy, his executive functioning skills are developing so he genuinely forgets and just needs a visual to prompt him.

Whenever we were encouraging L to use the toilet, we'd say the word "toilet" and sign the word as well. Initially L was non verbal, so by learning the key word sign for toilet, he had a means of communicating to us that he needed to use the toilet.

We incorporated L's intense interest of superheroes into toilet training. Every skill that L has learnt, his superhero figurines have been there every step of the way, including sitting on the toilet. This was a huge motivator for L - if his superheroes could sit on the toilet, then he was keen to do it too!

Initially we kept a record of when L was soiling and wetting his nappy and/or clothes. When we established the times that he would generally soil or wet himself, we'd encourage him to use the toilet at roughly around those times.

We would also use a specific phrase once L was sitting on the toilet, something along the lines of "L, wees and poos go in the toilet," so that he began to understand why he was sitting on the toilet.

L likes to be in control of what is happening around him so we'd give him choices based on an outcome that we wanted. We wanted him to use the toilet so we would ask questions like "Who would you like to take you to the toilet? Mummy or Daddy?" or "Which toilet would you like to use?" Questions along these lines made him feel like he was in control. If we ever asked him "Do you want to go to the toilet?" the answer was always no!

We'd also give L a visual countdown of when he'd need to go to the toilet - we'd also let him know that in five minutes it was time to go to the toilet. This certainly helped as without a countdown, he'd become quite distressed.

Other tips that could be useful ....

  • You could encourage your child to simply sit, fully clothed on the toilet and praise your child if and when they do. Start off with a small amount of time and work up to longer periods.
  • Some children find the noise of the toilet flushing overwhelming - so initially, simply get them to be in the vicinity of the toilet when you flush it and work up to your child flushing the toilet. Again praise them if this is successful along every step of the way.
  • Your child may have difficulty in dressing and undressing themselves so they may need your assistance in this.
  • Some children may respond to reward charts - a stamp or sticker each time that they use the toilet and a reward once they get a certain number of stickers. We did try sticker charts and other rewards with both little superheroes, but neither were interested. They loved getting the sticker but it didn't help in any way with toilet training.
  • Once you begin toilet training, you can encourage your child to go to the toilet every 45 minutes or so. Some children respond to this, others can be quite resistant.
And finally, if you begin toilet training your child and have no luck, stop and try again in a month or so. It could be that your child simply is not ready. Have a break from toilet training, for both of you, and try again at a later date.

Wednesday 19 February 2020

Adventures with My Little Superheroes.

One thing that we love to do as a family is take day trips. We pack the picnic basket, get into the car and pick a direction. Neither of my little superheroes enjoy the unknown - the element of surprise and unknown really throws them both off balance. But throughout life, we all will come across unknown surprises so both Daddy superhero and I want to prepare them. We want them both to know what while preparation for changes is great, every now and then they will come across a change that they didn't know about and that they will be okay.

So the day trips that we take serve two purposes - having fun as a family and preparing them for the future.

About a month ago we decided to go on a day trip and when we got to the motorway, both little superheros pointed south so that's the direction we went in. We ended up down at one of Daddy superheroes old stomping grounds on the south side of Brisbane. There's a great little (well not so little in the grand scheme of things) playground with huge old Moreton Bay fig trees at Wellington Point. After a picnic, both little superheroes took off towards the trees.

Each time we venture to Wellington Point, both little superheroes love to climb up and sit on the branches of the old trees. This time, not only did they just sit on one of the branches, they wanted to have a go at climbing/crawling/shuffling along one of the branches into the tree. This is a huge step, especially for O, as while L really doesn't have a sense of fear, the branches aren't the easiest to climb along.

But they both had a go, and with a little help from Daddy, they both made it into the tree! And not only did they have fun, but by climbing the tree, they gained a little proprioceptive input!!

After some tree climbing, we saw that the tide was on its way out. Each time we've been to Wellington Point, the little superheroes have talked about the little island that is located a short distance off shore from Wellington Point. What they both didn't realise is that when the tide goes out, there is a sand bank that appears that runs between Wellington Point and the island, King Island.

So off came the shoes and we made a snap decision to walk the sand bank to King Island! Now as the tide hadn't gone completely out, we had to cross a small channel to get onto the sand bank. We all pulled our shorts up as far as they would go and waded into the water. Me being my clumsy self, went bum up and was soaked from the waist down - thank goodness, I'd wrapped my phone in a few plastic bags! Both little superheros, and Daddy superhero and the people around us, had a good chuckle. And both little superheroes reminded me "Mummy, you don't have dry clothes in the car. Now you're wet, you going to have to walk home!"

King Island is situated approximately 1 kilometre out from Wellington Point. The island is a conservation park and is a combination of sandy pathways alongside trees and it is surrounded by mangroves. It is uninhabited now, but in the early 1900's, the island was once home to the Phillips family for medicinal reasons - one of their seven children had polio and it was suggested to them that the child would benefit from bathing daily in the sea water. They built a makeshift home on the island and lived there for a number of years.

The walk out to King Island was quite lovely. At one point L told me "It very peaceful out here!" and that it was. We took our time walking out, stopping to look at the coral and shells that were washed up on the sand bar.

The walk was a little too much for O. She did make it out to the island but the shells and coral along the way was too much for her feet. So once we'd made it to the island, she and I headed back while L and Daddy superhero explored the island.

As you can probably tell from the photo, L had a ball bouncing, running and jumping all over the island.

On our way back to Wellington Point, O and I had a talk about what we had learnt from the walk as by that point O was quite teary. Her pain threshold is quite low compared to L's so I wanted to try and take her mind off of the walk itself.

We decided that next time that while we'd take our shoes off to cross over onto the sand bar, we'd bring our shoes so that the coral and shells didn't hurt O's feet. It is wonderful to see her problem solve issues that she comes across as it means that in the future, she will have these skills to help her in every day life.

At one point on the way back, O spotted a lump of dead coral. She knows that as a teenager and young adult, I had my heart set on becoming a marine biologist, so she is always asking me questions about marine life. The coral that she happened to pick up had two, that we could see, different marine creatures living on it. There was a black and brown chiton (a marine mollusc) sticking very tightly and moving very slowly along one edge and in a burrow was the tail end of a mantis shrimp - it was madly clicking as we looked at the coral as if to say "put my home down!"

All in all, it was a great day out. Both little superheroes are already talking about the next time we walk to King Island and what we need to take so that we're a little more prepared. They both did really well to walk the 2 kilometre round trip to King Island, as we kept reminding them - it was the longest walk that they'd both done in quite some time.

Oh, and I didn't need to walk home - we'd packed towels just in case we ended up at a destination where the little superheroes could swim!

Saturday 15 February 2020

L's Speech Therapy Journey

Four years ago, on the 2nd of February 2016, L began early intervention therapy which included Speech Therapy and Occupational Therapy, at an amazing Early Intervention centre called Little Stars with the Autism Association of Western Australia. Little Stars rapidly became known as Tara's School due to the bond that one of his therapists, Tara, built with L. 

L's first day at Tara's School was a nerve wrecking day for all us as L's verbal communication skills were still developing. He did a lot of stimming we initially arrived but by the smiles on his face when we collected him after his session, he had had a ball.

Since that date, L has been attending weekly speech therapy sessions and over the last four years L has made huge leaps and bounds and he is continuing to move forward.

Last Wednesday afternoon, L came to the end of his speech therapy journey. It really was a bittersweet moment as all of his speech therapists have become extended family members. They have all invested a lot of time, both professionally and personally, into developing L's abilities as well as encouraging him on his Autism journey. But as his Speech therapist said on Wednesday, L has come to the end of what a speech therapist is able to do. In looking at the scope of what a Speech Therapist can do, L has reached the end point with speech therapy.

So now we're down to Occupational Therapy and psychology sessions!!

I am so very proud of just far L has come. He's faced many obstacles, and will probably face more going forward, but so far he has overcome everything that he has faced. From a little boy who struggled to understand his own, and others emotions, who was non-verbal to the talkative, mischievous little superhero that he is today.

This little superheroes future is very, very bright!