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Potty training reluctant 4 year old


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I'm posting here rather than the chat board because ds4 is really not neurotypical and I suspect I'll get better advice from you all.

 

Most of my kids have been on the late side when it comes to potty training, I've mostly just waited until they are ready. I've never had a four year old still seemingly not ready though. Thing is we are all set to try out a montessori preschool that I am really hoping will be a good fit for him but...he needs to be potty trained!

 

I've been trying for a week now, and we have more misses than hits. We had a couple of successes today, then this afternoon he went to hide in a corner when he needed to poop then proceeded to smear the proceeds all over himself and everything around him. He'd already pooped earlier so I really wasn't expecting the encore. I've been bribing him with treats, but even so I'm not getting any real buy in. I've let him run around naked thinking that might help, but it just makes "accidents" more amusing for him.

 

Ideas?

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My SN child had been #1 trained on a schedule for about 6 months with no luck on #2 by the time that her integrative doctor treated her for systemic yeast infection. The hope was that the anti-yeast treatment would reduce her hyperactivity, which unfortunately didn't happen. But a very welcome side effect was that she started going #2 on the potty regularly and was totally day-time trained (on a schedule) within a week.

 

I think that it's definitely worth seeing if your doctor will prescribe a course of Nystatin. That has a very good safety profile so while it may or may not help, it's not likely to hurt.

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My ds didn't even BEGIN to do any potty-training till 4 1/4.  Well I take that back, I did the pee on command thing I learned in Russia (diaperless baby-training) when he was little.  So he could pee on command, yes.  But to tell me and organize it and go, no.  And when he did finally start and notice, we had funky things going on with repetitive behaviors, him not being willing to wipe.  The wiping was a sensory/proprioception thing.  

 

Honestly, I'd get him eval'd and diagnosed.  You sound like you really need some help, some relief.  

 

Back to pottying.  My ds was wetting 3-4 times a day up until this past school year, so like well into age 7.  The OT gave us Therapeutic Listening music, and that reversed it very quickly, like a miracle. He will still be wet on occasion when his system gets really overwhelmed.  He wears GoodNites at night and has a bed liner (actually multiple).  

 

I'm saying I wouldn't assume this is going away, because it's probably not, not with what you're describing.  This would be the time to bring in help.  Pottying is sorta the least of your worries.  It's more what's making it this hard that is the worry.

Edited by OhElizabeth
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My ds didn't even BEGIN to do any potty-training till 4 1/4.  Well I take that back, I did the pee on command thing I learned in Russia (diaperless baby-training) when he was little.  So he could pee on command, yes.  But to tell me and organize it and go, no.  And when he did finally start and notice, we had funky things going on with repetitive behaviors, him not being willing to wipe.  The wiping was a sensory/proprioception thing.  

 

Honestly, I'd get him eval'd and diagnosed.  You sound like you really need some help, some relief.  

 

Back to pottying.  My ds was wetting 3-4 times a day up until this past school year, so like well into age 7.  The OT gave us Therapeutic Listening music, and that reversed it very quickly, like a miracle. He will still be wet on occasion when his system gets really overwhelmed.  He wears GoodNites at night and has a bed liner (actually multiple).  

 

I'm saying I wouldn't assume this is going away, because it's probably not, not with what you're describing.  This would be the time to bring in help.  Pottying is sorta the least of your worries.  It's more what's making it this hard that is the worry.

 

We've done evaluations, all we can manage for now.  I think there's more going on than he has been diagnosed with but pursuing anything further is going to have to wait. 

 

If I can get him moderately trained he can go to preschool, it is only a couple of hours a day and he could probably wear pullups if needed.

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DD was in a 3k program that required all students be potty trained but she was the youngest in the class and was not. She had executive function issues and no sense of sequence or the passage of time. Potty training was hard for her and there was no bathroom in the classroom. They took scheduled potty breaks as a class. I talked extensively with the school and they finally allowed her to wear a pull up. The caveat was that if she pooped either she cleaned herself up or I had to come to the school to do it for her. Nothing I specifically tried helped until she was a bit older and more developmentally mature, which included not just physical maturity but also finally internalizing and caring about the fact that she was the only one in her class still potty training (which took months).

 

You might try charting when he poops. See if there is a pattern. Maybe you could time food intake to adjust when he poops so he perhaps would not poop at school? I realize that would be very challenging to accomplish.

 

What does your pediatrician say?

Edited by OneStepAtATime
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Toilet Training for Individuals with Autism or Other Developmental Issues: Second Edition

 

This is the book I'm reading right now to see if there are any tips on how to handle the nighttime stuff.  It's very balanced and might give you options.  You do have in-between options, for a dc who is not independent with pottying.  He's not telling you when he needs to go, but you *can* train him to go on a schedule.  A preschool would have a schedule too, one that probably fits what is developmentally, physically typical for kids that age.  So you could potty-train him to their schedule, meaning he goes when told, with you using that schedule, and use pull-ups, yes.

Edited by OhElizabeth
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Though one way to address this? Is when they notice the 'urge to go'?

To tell them to wait for 3 or 4 minutes?

 

What is behind this, is firstly to develop a sense of the pressure within the bowel and bladder.

To develop a fairly accurate sense of how full they are?

Which we need to learn how read.

 

Also the 'waiting for a few minutes'?

Provides practice with controlling the sequence of muscles that are involved.

 

 

 

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My ds never noticed, not for years and years.  Then when he did start noticing, because of his sensory and immaturity, it was like REALLY INTENSE and urgent by the time he told us.  I know I've read it books that it's constipation.  Fine, whatever, but he wasn't constipated.  He was just really neurologically disorganized.  So we'd be driving somewhere and all of a sudden he was CRYING that he had to go.  That was ages 5-7, mainly 6-7.

Edited by OhElizabeth
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  You do have in-between options, for a dc who is not independent with pottying.  He's not telling you when he needs to go, but you *can* train him to go on a schedule.  

 

Yes, this. It took years for my child to go from trained on a schedule to verbalizing the need to go and using the toilet totally independently. We just had our 6 month review of her ABA program and the BCBA finally took "pottytraining" off the program (it had been in "maintenance") since she didn't have any accidents during the previous six months.

 

Night-time she's still in Pull-Ups and probably has a wet one 1-2 times per week. But that's actually fairly common in the family (one sibling wet the bed until 8 and a relative did it until 12).

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My 5 year old with ASD has been in underwear for about 6 months now, but I wouldn't call him fully potty trained. He wears pull ups to bed and has accidents about 2-4 times every day. I keep him in underwear because he will at least make an effort to get to the toilet once he notices that he's starting to go in his pants, whereas he will not even try if he's wearing a pull up. To even get him to this point, I had to offer major incentives. We spent days bribing him with candy to simply stand in the bathroom and count to ten. I set a timer and when it rang, he had to stop what he was doing (difficult for him), run to the bathroom and count. Then once he mastered that he had to pull his pants down and count. We slowly moved up to sitting on the toilet, etc. For poop, we had to bribe him with really good toys. He couldn't do a sticker chart, so for every poop he earned a $5 toy. It cost us a fortune, but it was the only thing motivating enough to make him want to try. I think the first couple of poops may have cost more lol. Also, coupled with this, we started making him change his own diapers (with as little help as possible). He LIKED being in diapers, and STILL wants to wear them, so I had to make that experience as unpleasant as possible since he had absolutely no good reason to stop wearing them in his mind. There were other kids in his class (special needs) who wore diapers, so I couldn't convince him that they were not for 4 year olds. Not that he would have cared anyway. Now that he's in underwear, he seems to be on the right track. He's using the toilet independently, for the most part. He peed all over the floor a few times, but making him clean it up (with as little help as possible) solved that problem very quickly. He makes it to the bathroom without first starting in his pants a couple of times per day, at least. He hasn't had any public accidents. In my book, this is major progress.

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