Thursday, October 7, 2010

Phase 1 Potty Training: Dogged Perseverance & Continuity

I've boldly announced that my boys are potty-trained in a recent post.  And our school district totally agrees!  They are!  We are collectively right -- and simultaneously wrong -- depending upon how you define potty-trained.  Yes, the boys use the potty all day long to go pee-pee.  They wake up dry in the morning and I take them to the bathroom.  Then they go through their 6-hour kindergarten day without any accidents.  They come home and use the bathroom immediately upon being reminded.  And there's the hitch... At home, they MUST be reminded MOST of the time.  Occasionally, they get up and go on their own but that is the exception... at home!  At school, they go regularly and on their own... because everyone else goes regularly and on their own.  Children around them all day long, raise their hands and are excused to go potty.  The Boys do the same.  But, at home, we're not raising our hands and announcing it every time we have to go potty.  We all just get up and go to the bathroom... when ever nature calls.  The Boys go, but not always, every single time, to the bathroom.  Accidents still happen many days at home in the evenings when the business of our lives gets in the way of the pottying reminders.  Time slips by and the pee-pee occasionally slips out.  But, we've developed a methodology and process for that too!  So this is our potty-training reality.  They are Phase 1 Potty Trained! 

So let's delve into the nitty gritty of how we successfully achieved this first phase of the potty training process!  I'm no better at this than anyone else and there's no magic to it nor any one method that will work for any one -- or two, in my case -- of our kids the way it works for any other child in particular.  I just kept reading other successful accounts of potty training children with special needs (and those without) until I found and formulated a hybrid method I thought might work for MY Boys.  Then I implemented it doggedly and tweaked it until we hit on a process that actually did work for us.

As an Inclusionist parent, with Kindergarten in our near future, I needed The Boys to be potty-trained so that their toileting habits could not be a factor, nor influence the Committee on Special Education (CSE), with regards to their placement.  Though the law allows for un-potty-trained children to participate in "regular" kindergarten classes if the inability to potty train is deemed part of the child's disability,  I have found that too often this particular disability does play into classroom setting decisions (the diaper changing task changes everything).  I was NOT about to allow this factor to influence my Boys' placement!  So my deadline was set for me at September 7th, the first day of school. 

My daughter trained in one weekend with nearly no effort or purposeful intervention on my part.  At nearly 5, that was obviously not going to be the case with The Boys.  So I asked others' advice on my Down syndrome listservs and received lots of ideas and read books, articles and online posts about lots of recommended, tried and true potty-training methods. Some said sticker rewards systems. Others said co-training (have your child train their toy/doll/action figure while you trained them).  And yet another touted constant nakedness to allow them to feel the consequences of NOT using the potty up close and personal (a method best used during the Summer and outside so as not to wreck your carpets and furniture). All included interesting components that I made note of but it wasn't until I hit upon timed intervals that a hybrid method began to develop for me and my Boys. 

I googled clocks, stop-watches and timers until I happened upon the $20 Gymboss interval timer that allows 99 trials of timed intervals ranging from 1 to 99 minutes programmed at the user's discretion.  It's a tiny little timer with belt clip and the ability to choose vibrate and/or alarm to last 5 or 10 seconds, again at the user's discretion.  I bought packs and packs and more packs of Spiderman and Toy Story underwear (remember I'm clothing/training two!) and chose Friday after school as our starting date... to give me the weekend to foster some recognition of the process before I sent them to school on Monday.  I also pre-enlisted their school's teachers and aides to actively participate in the process as the hand-off to school was made.

Prior to starting their potty training regimen, I'd spent months before and after their bath, having The Boys urinate on command in the handheld pot that usually sits inside the potty chair that they'd long ago outgrown.  By counting slowly to 10 we would usually meet with some success (and they were counting pretty well too!).  Slowly, I'd migrated that process to actually standing and urinating on command in the toilet... Again, only before and after their bath. 

So, on the designated Friday afternoon when we got home from school, I took off their diapers, brought them to the potty to void their bladders and put on their first real pair of underwear.  I set the timer for 20 minutes and waited. Within 5 minutes there was a big puddle at the foot of the stairs with My Little Man standing over it saying, "Wet!"  The next 40 minutes were fraught with puddles and soaked through undies.  Slow learner that I am, I finally changed the timed interval to 10 minutes as a starting point.  I'd read about errorless learning where children are taught slowly and steadily the right way to do something, never experiencing or having to unlearn the wrong way.  Unfortunately, I blew that milestone which, I think, was probably not such a big deal since peeing in diapers seems to already be the "wrong" way with regards to learning how NOT to pee in ones' undies. 

So here's the down and dirty on how we progressed:  Interval timer was set for 10 minutes.  As soon as the buzzer went off -- without exception -- I'd take My Little Man and walk him into the bathroom, drop his drawers in front of the potty and, with my arms lovingly wrapped around him from behind, verbally encourage him to urinate.  He did... every time.  Together we'd pull up his undies then his shorts and flush the potty.  Wash his hands then rinse and repeat... with the Big Little Man.  Despite mild protests, both boys voided.  We kept this up for the better part of an hour without "accidents" before I moved the timer to 15 minutes and then quickly to 20.  At 20 minutes I discovered that humans cannot pee indefinitely every 20 minutes and a Mom can lead a boy to juice but cannot MAKE him drink.  Still, we kept up the routine and rewarded honest attempts (a droplet was acceptable) with praise and hugs and hi-5s  -- 'cause that's what works best for MY Boys -- throughout the evening.  We had one brief (get it? versus boxers...) accident and then stayed the course -- clean and dry -- for the next 2+ hours.  By Friday night, the boys had managed 5 hours of clean and dry with only one accident (not including our first 40-minute mis-start).

I chose not to attempt night-time potty training at this time!  The boys usually wake up dry and quickly "go" but a restless night often results in a urine-soaked morning diap so I opted to stay the course with the overight diaps.  That said, I put the overnight on them and we all went to bed.  As soon as I heard the first giggle on Saturday morning, I brought the hand-held potty insert upstairs (FYI -- we don't have a bathroom upstairs... which presents consistent difficulty in the toilet-training process) and had both boys void.  Once downstairs I put the undies on again and we restarted at 20 minute intervals.  All day long -- we went nowhere and did nothing but attend to that timer -- the boys did amazingly well.  By afternoon I upped our interval to 25 minutes, then 30 when and the boys crashed.  Several accidents later, I pushed the timer back to 20 minutes to try and recoup.  Their resolve to pee-on-the-pot deteriorated as the evening wore on.  Sunday came and we started anew... again.  We maintained the morning hand-held pot routine and 20 minute intervals, and The Boys were at the top of their game again.  Until afternoon.  To remedy a messy situation, I put an overnight feminine hygiene pad in their undies to catch most of the mess.  It worked for me and didn't seem to send them back down diaper-memory lane.

On Monday morning, I packed a big bag of undies and feminine hygiene pads, wrote out my instructions and stuffed it into their backpacks.  I followed our established protocol EXCEPT I put them in a pull-up for the 50-minute drive to school with undies & sanitary pad over top.  I handed off the Gymboss while the Teacher and Aide removed the pull-up upon arrival.  The Boys did FABULOUSLY staying dry the entire day!  By the end of the day, the Teacher's Aide, Ian, who also happened to be "assigned" to their potty training and was their favorite person in the world at school, had bumped the intervals up to 45 minutes.  The Boys followed their classmate's leads (The Boys attended an integrated preschool class with 50% of the class being "typical" and 50% having special needs), raising their hands and going to the bathroom -- with little assistance -- all day, and then all week long.  By the end of week one, the school had removed the sanitary pad safety net and had not experienced even one single accident all day, or all week long. 

We, on the other hand, continue still to meet with marginal success/occasional accidents in the afternoons and evenings.  I'd put The Boys at 90% success rate.  That's awesome, in truth.  As for the other 10%?... I am absolutely 100% to blame for this.  Not only did I make the assumption that their school success would translate to home success -- not true -- but I did not unequivocally honor the timer.  THIS continues to be my bad.  When I do not honor the timer, which is now set at home for 30 minute intervals, we experience accidents.... more so for my Little Man than my Big Little Man who, it seems, could hold it for 2 hours and withstand significant pain to do so until he's brought to the potty to go.... mostly.  I can skip one round to go 60 minutes most of the time.  BUT, when I DO honor the timer, all is well, clean and dry 100% of the time!  THAT'S EXTRAORDINARY!

So, this is our new normal.  We are timed-interval potty trained.  At school, The Boys know to go potty  when transitioning between activities... which, in Kindergarten, effectively happens every 30 minutes.  They do not use the interval timer but use gentle reminders only as needed.  At home, we live by the Gymboss.  Some would say this is an intrustion on our lives and not much of an improvement over diapers since we only needed to change a diaper every 2 hours or so.  But, in order to foster the independent toileting skills they'll need in life... This is what we have to do for now and until The Boys accept the full responsibility for "going" themselves.  This will happen -- like everything else -- in their own time!  I'm OK with that!

As for #2 training, I would never claim that the boys are potty trained for bowel movements.  Yes, they both can, have and will poop on the pot if given the opportunity when nature calls.  And, since nature has blessed them with pretty regular bowels, most of the time, the need occurs in the evening and/or right before bed. (It has only twice called during 2 years of preschool.)  Knowing this is a Godsend because we can watch for the telltale signs -- hiding in the corner, grunting or outright announcing, "poopy hurts" -- that triggers the frantic (not really, but sorta) run to the bathroom to "catch it' on time.  Otherwise, we have a double-duty (LOL) accident on our hands because we can all understand the pee-when-you-poop phenomenon.  To minimize the negative effects of this happenstance, I briefly and/or occasionally go back to using a large overnight sanitary pad (I prefer Kotex overnights) in the afternoons/evenings... particularlyy when pooping alludes them for a day.  But, mostly, if I find The Boys and I are having a particularly rough time sticking to the [Gymboss] program -- for #1 and/or #2 -- I implement the New York Times Naked Toilet Training technique by removing all clothing from their bottoms, stripping them down to bare skin (Thank God for long shirts).  The Boys NEVER urinate when around the house when they're naked.  They might lose a drop or two but quickly catch themselves and announce it so we're off to the bathroom again.

Yes, they are potty trained!  It's not perfect... but they're 5 and they're only 3 months into this process.  All in all, they've done PHENOMENALLY WELL!  And, I am beyond pleased with their rapid progress.  Could we all do a little better (Note I said WE because I do see the difference when I slack)?  Sure.  But, our success is palatable.  They're included in the Gen Ed class at school for most of the day, their toileting habits never coming into play in the decision-making process.  And, given some of the nightmare accounts of potty training I'd heard before I started, I'm very pleased with our outcome. 

Did we/do we continue to make mistakes?  Yes, but tweak-and-learn has become my motto.  Below I've listed some of the mistakes I believe I made make on a pretty regular basis and to The Boys detriment:

  • The hand-held insert potty made us all lazy, I think.  At home, The Boys seem to wait around, preferring for me to bring it to them instead of taking the responsibility to get up and go to the bathroom.  Convenient, yes.  NOT conducive to what small sliver of errorless learning there might be left.  I have to STOP using the hand-held and make us all go to the bathroom... like in the real world... if I ever expect independent toileting skills.
  • Honor the timer.  Honor the timer.  Honor the timer.  I don't!  Life gets in the way.  There are days where the 10 seconds of beeping barely register in my brain.  NOT good!  I've got to get better at this or we'll end up with more accidents than visits to the pot and I'll start to see my potty-trained Boys resorting to urinating in their pants more regularly than urinating on the pot.
  • Honestly, I think the pad may be a mistake.  It seemed like a really good idea when cleaning that 10th pair of undies and/or the HUGE wet spot on the couch.  However, I think The Boys see it as just a smaller diaper which gives them permission to go.  After all, they've spent the better part of 5 years peeing in their diaps, that muscle memory is much stronger yet than holding it and running to the bathroom.
  • Believing that success at school translated to success at home.  The social situation at school is completely different than at home.  Humans are pack animals and will follow the pack.  At school any fraction of 20 children are clamoring for use of the bathroom at any given time.  At home, asking Daddy to hurry up is an exception.  No one's raising their hands or announcing their use of the bathroom.  As such, the peer training at school is so much more intense than at home... which puts the onus on... MOMMY (let's be honest) to make up the difference. 

Those Aha Moments:
  •  Afternoons are our tough time.  The Boys have worked hard to be good all day and are, as they say, "all done!"  That means beefing up the toileting routine at home to stay on track.  I found out that when I work it, it works!  When I don't, they pee everywhere but on the pot.
  • The pad is cheating and, though it may ease my "load", it may well be keeping them from learning.
  • Going straight for the stand up routine makes more sense than teaching them to sit down to urinate and then un-teaching them to sit down in favor of standing.  I read that unteaching is tough in children with Down syndrome.  Maybe, maybe not.  But it seemed way more logical to me that if I wanted them to pee standing up I had to teach them to pee standing up.... It's working for us. 
  • Boy does as boy is... or sees.  Daddy HAS to be involved if you're going for the stand-up routine.  Mommy can't show The Boys how to do THAT!  Even positioning, like holding it, appropriate stance to keep drips from your pants and shaking off those last few drops are techniques for Daddy to share effectively.  I can talk 'til I'm blue in the face... but once they've seen Daddy do it, it's cool.
  • Humans are pack animals.  Seize the opportunity to follow the crowd... to the bathroom.   My Boys really like being part of the IN crowd, doing what everybody else is doing. 
  • Sometimes The Boys seem to forget how to activate the pee-pee muscles to urinate.  When this happens, I patiently wait while lightly scratching on the fat pad above their penes (correct plural... which makes me want to laugh 'til I pee my pants every time I say it) to activate the appropriate muscles.  Works for us!
  • The Boys often lose interest in the process midstream... literally.  To keep them "going" I point out the pee pee bubbles that develop as a function of peeing in the pot and/or I encourage them to aim as far as they can to hit the inside-back of the toilet bowl. 
  • I find that if I don't get them to void completely we're far more likely to have a mid-interval accident.  I've come to recognize that when a full-stream of urine stops dead, they're holding back.  And, the only way I know they're really ALL DONE is when the stream peters out (perhaps the origin of that phrase?) and we trickle down to droplets. 
  • At this juncture, they're potty trained enough so that when we have someplace to go where cleaning up an accident might be awkward, I can put a pull-up on The Boys and know that they will still hold it and/or tell me when they have to go to the bathroom.  They're not regressing just because there's a diaper between their legs.  That's HUGE progress!
So this is my take on it:  No child is the same -- with or without special needs or Down syndrome.  No single potty-training method will work for all of our children but a combined approach worked for me.  Nothing  -- no outcome -- is perfect.  This is a process!  Once you accept these truths,  go ahead and formulate a plan of your own and go forth and potty train.  If you hit a wall... don't quit!  Ask questions, tweak your method and keep going.  We are ALL here for you!  Please feel free to comment, email or Facebook me any questions about anything I've said, how we handled any aspect of our Phase 1 Potty  Training endeavors OR about any issues you're encountering.  I'm happy to offer my opinion... but please remember, that's all it is... One newly-potty-trained Mom's opinion!

Most of all, good luck and stick to it with dogged perseverance!  No matter how long it takes, it's totally worth it especially when you consider what the alternative -- NOT potty training -- means for you and for your child.


THE END
(or just the beginning?)

7 comments:

  1. what a wonderful resource for all other moms! I'm sure it must have been almost as hard to right it all down as it was to do the program. I love my gymboss for running - and maybe someday I'll find a use for it with the girls too.

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  2. I may have to look into a Gymboss.. Interesting routine. I have been in the complete beginning stages of potty training my boys. We have them sit on the potty right before getting into the tub, thats all they do is sit and then they get into the tub and pee in the water. Never fails. I may have to try holding the little potty up thingie in their stream like you mentioned. That might give them an idea of thats where its supposed to go boys. Thanks for sharing your experience. I know its not going to be easy, but I too want to try to get them trained before they start kindergarten next year.

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  3. I had to laugh at parts of your post. I really, really appreciate your honest, pull up the sleeves kinda step-by-step that worked for you and the boys. John Michael is almost 3 and I've been wondering when he'll realize he is peeing. He actually pats his chest when he has to poop, but I"m not convinced he's aware of the other. Thanks for the tips! Great job to your boys!

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  4. Thank you for sharing this. My 4 year old son is autistic and I've been struggling with the potty training. I appreciate you taking the time to share!

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  5. This was SO helpful! We've been putting Sheridan (2 yrs old) on the potty before bath time (it never fails, he pees as soon as his toes hit the water) so he can have some success and just start the learn the association. This post is so helpful for when we're ready (not for a long time yet) to start the real deal!

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  6. I would have fun with what he has in his undies

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  7. I would have fun with him too

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