Toilet training and self-awareness questions

Post Reply New Topic

This post is to cover two of my most pressing concerns as I didn't want to take up bandwidth by making multiple threads.

My first concern is toilet training. My son is 75% schedule trained, but we still have accidents galore. Rather than saying that he is on a schedule, I should say that *we* are on a schedule. We take him every 30 minutes and this intensive routine has minimized accidents. The accidents occur if one or the both of us "forgets", and even if we are a minute late

He does not seem to get the concept of holding it in until he is safely on top of the toilet ! Last night, we took him bike riding at a park behind our house. About 10 minutes into the ride, he jumped off the bike, squat in a corner and had a massive, mother-of-all-bowel-movements before we could rush him to the nearest restroom ! It was horrendous and very discouraging.

How can we teach him to "hold it in" ? I think he needs to learn this first before we could even DARE to try to teach him independent toileting !

My second question involves self-awareness. I read somewhere that by age 2, most human children can identify themselves in the mirror or in a photograph. That, by age 4, most non-human great apes get the concept of self and can identify a picture of themselves !

Well, my son is a human great ape, almost close to 5, and he does not know himself in the mirror. We have large floor-to-ceiling glass mirrors on our bedroom closets, and every morning, my husband patiently dresses him in front of the mirror (aside from brushing teeth in front of the bathroom mirror), naming every action "Pants on <his name>", "Now <his name> arms up" etc, while our son faces the mirror and watches himself getting dressed. Hubby also tries to get him to kiss his (son's) image in the mirror, and my son will purse his lips and smooch the mirror, IF you gently redirected his face to his reflection.. BUT, if you asked him to point to himself or to touch his reflection, he can't

He also does not identify himself in a photograph.

We recently placed a giant mark on his forehead to see if he would notice anything different about his image. Most human toddlers and juvenile great apes immediately touch their face if they see the marks in the reflection, but he didn't.

How can this be ? How can chimps and gorillas and bonobos and even baboons have the concept of self and my human child does not ? Anyway, is there a way to teach him the concept of himself as a separate identify from his Dad ? (I suspect that he thinks that he is an extension of Dad to whom he attaches himself as much as he can).

Help !

Last edited by HisMom on 03 May 2014, 3:04 am, edited 3 times in total.

Toilet training- I have no idea, as you know.

Identifying himself- if he has poor receptive language, is it possible that he does identify but doesn't understand that you're asking him to point to himself? Even my verbal son has this issue. For example, when he plays with Mr. Potato Head alone, he identifies what he's putting on verbally ("Hat", "Eyes", "Mouth", etc.), but if you ask him, "Where is his hat?" he'll just repeat the question, or if you instruct him, "Put on the hat", he'll just repeat the instruction unless you give lots of prompting. But he knows what the hat is, he just can't answer the question.

If you leave the mirror in his room and have dad not be in the view of it, he will see himself alone. We have a mirror in our boys' room too and both of my kids did go through a phase where they looked at themselves in it and experimented with it, but they did it on their own. Since your son likes to do visual stimming, you could incorporate that with mirrors. If you buy a bunch of little mirrors, you can reflect light in interesting ways and stuff, and in doing this, he will see himself in it too.

That is a great idea to leave him alone in his room so that he sees himself alone, and not with his father. But, that would mean that we will not find out if he DOES experiment with the reflection as we won't be around to see it. The mirrored closets are enormous and it is difficult to be in the room and not be seen in them.

Hubby was saying that there are times that he smiles at the reflections but it is hard to say if he is smiling at Dad or at himself. Thing is, he probably does match Dad's reflection to Dad, but does not get the idea that the little boy in the mirror is him.

That mark on the forehead was a slap in the face for us. If he is able to correctly recognize that mark, then we know he has a concept of self.

Around what age did your kids start liking the mirror, Holland ?

I do not have any special expertise in this, but I would put the mark on his hand, first. Here is my line of thinking: If you put the mark on his forehead, he cannot see it on himself. (I know--that is probably the point) If he has short term memory issues, he will not remember you touching him there with the marker. If you put it on his hand, he can look at the mark on his hand and then look in the mirror, and back and forth as much as he likes, to reinforce it. This seems like a necessary step, somehow.

Whenever we have trouble, I always see if I can brainstorm a more basic, foundational step to see if I can get that to work, and it helps me know where we are.

Regarding WelcomeToHolland's idea: As crazy as it may make you, I don't think dedicating some time to things you cannot observe is a bad idea. He may feel more comfortable to explore when unobserved. You can "test" it by seeing if he makes progress during your regular mirror ritual after he has had a chance to do this for awhile. There is a parent who posts here sometimes, who has a son who is especially self-conscious when observed. It made me think that you never know when kids feel that way.

One good sign here is the fact that he jumped off the bike to squat. That shows that he is at least somewhat aware that he needs to go to the bathroom, which is necessary for getting him to manage it himself. There is an excellent book on toilet training called toilet training in less than a day. It's a bit old and written for typically developing kids, but the principles still apply (though it may take more time). It is considered one of the gold standard books on this topic and it also teaches you some general parenting tricks. So I highly recommend it. http://www.amazon.com/Toilet-Training-L ... 0671693808

The idea of placing a mark on his hands is an excellent idea, since that might actually teach him that the little boy in the mirror does look like him. Also, if he is left alone, and it is just him and the reflection, he may eventually make the connection. It is certainly worth a good try. And maybe we can repeat the mark-on-forehead experience a month or two later and see if he recognizes himself in the mirror.

Thank you, ASDMommy.




He is developmentally not at the stage where using a doll to model toilet training for him will help. Azrin and Foxx is still an excellent book, but I doubt that I can apply their toiletting ideas to train my boy. Social imitation is not his strong suite, so the protocol may not work for him, unfortunately.

I came across this book on Amazon one day while looking for other titles about autism:

Toilet Training for Individuals with Autism or Other Developmental Issues: Second Edition by Maria Wheeler and Carol Stock Kranowitz

No idea if it's any good or not, though it does have 51 ratings averaging 4.5 stars.

I was thinking more about their use of reinforcement techniques and fading reinforcement (dry pants checks and reinforcing dry pants), so that once the child knows how to use the toilet, they become motivated to do so consistently. Your son sounds like he's half potty-trained, so you can obviously skip a few steps, but some of the insights in that book may apply. Then again, something more specialized may be helpful as well.

Thank you, zette. I own other books by Carol Kranowitz and find them extremely useful, so this book may be just what I was looking for !




That is true. One problem we face is the inability to increase the time between two potty sessions. We have been stuck at 30 minutes and it is EXHAUSTING. One visit usually takes about 10 minutes long, and before you know it, it is time to repeat the whole cycle of steps again.

We tried to slowly up the interval limit to 35 minutes but only encountered accidents, so that is big concern for us. We recently had a medical exam done to rule out bladder control issues, so the inability to hold "it" in for more than 30 minutes appears to be more behavioral than medical.

Any tips or suggestions for us, Emile ?

Brief disclaimer, I've got a passing familiarity with potty training, but I'm not an expert on the topic. Let me just make sure I'm following this - is he going consistently every 30 minutes? Or is it just that you need to prompt breaks every 30 minutes or risk an accident (i.e. you can't trust him to tell you that he has to go).

If it's the former then first you have to rule out medical issues, then consider what you are reinforcing...if you are giving him rewards for peeing, then you may actually be encouraging him to stop his pee so that he can be rewarded more often. It's the reason that they recommend switching to rewarding dry pants after the initial going on the toilet part is mastered.

If it's the latter, first consider - does he know how to signal that it's time to go? Has he ever done it? I'm assuming he's got limited language skills, but I'd also make sure that he's got a way to indicate bathroom (verbal, sign, picture, etc) so that he can start telling you when it's time. Whenever you see him doing something that indicates he may have to go, then prompt him through requesting a bathroom break, then take him there, and if he produces, reinforce him. Once he knows how to request it, you reinforce him like crazy for requesting. Then when he gets that concept, you switch to dry pants checks and reinforcing dry pants. You may want to consider letting him have some accidents, rather than scheduled bathroom breaks. Then also include the natural consequence of making him have to stop whatever he's doing and help clean up when he has accidents (put the pants in the laundry, clean himself off, get some more clothes). That's usually fairly aversive, so it's like a punishment, but it's a natural consequence, so I think it's fine. You can also get diapers and underwear with built in alarms for wetness. That alarm lets you immediately stop him from wetting when the wetting happens, and remind him of where he's supposed to go pee, and then have him help clean up immediately.

It seems like you're already fairly knowledgeable on the topic, so I hope I'm not just repeating what you've already tried.

Emile's post reminds me -- I was thinking about getting a bedwetting alarm for my son (still having accidents at age , and there is a site comparing all the different brands. It has a special-needs page with recommendations about which alarms to use for daytime wetting, etc.

http://bedwettingstore.com/alarms-for-special-needs.html

Just following this topic... also still struggling with toileting here.

I don't know if this is something unique to my son but he obsessively picks at any imperfection in his skin(or even mine!) like scabs or mosquito bites if he sees them, until it hurts or even bleeds. He has picked open scabs I had when I was sleeping

It is a bit of both. We load him up with lots of liquid and salty foods, so he is usually ready to go every 30 minutes but not always. AND, if we don't prompt breaks, we have huge accidents on our hands. He does not have the language to tell me or his Dad that he needs a potty break. He also hasn't seemed to get the idea that one only voids on the potty and not anywhere else. He knows to go on the toilet but not that it is the ONLY place to go.




This is excellent advise ! Thank you, Emile.

No, he has never requested a potty break. He also is not discomfited by being in a wet or dirty underwear, which is an added complication. The times there are accidents, we usually discover them because of the smell or because of the wet pants !

Since he does void on the potty, it may be time to reduce the liquid and salty food intake and move on to reinforcing requests for toilet breaks. Unfortunately, it is really hard to know when he is going pee, although we can fairly make out when he needs to poop (red face, grunts etc).

One thing I can think of is to make him give me a picture of a potty prior to taking him into the toilet for a scheduled break and see if that generalizes to independence after a few weeks of "training".

We had two pee & a nasty poop accident today. I made him empty the poop into the potty himself and he was really upset and resistant. This is going to be a challenge.

Do you have any ideas to increase the time intervals between two toilet breaks ? We tried to increase it to 45 minutes this afternoon, and were rewarded by the afore mentioned accidents for our efforts.

DS did not toilet train until we made it unpleasant for him. That meant regular underpants instead of pull-ups, making a big deal about how disgusting it was when he messed them, and making him help clean the mess.
We tried for months with the happy-potty-dance approach, but once we switched tactics he was trained in 24 hours.

If you're loading him up with liquids and salt, presumably this is done in order to maximize the times that you can practice potty training. The reason that people recommend doing that with regular (every 30 minutes) bathroom break is so that you can catch the person releasing on the toilet and reinforce that. I'm assuming you've already done that some so your son is now able to release on the toilet. The fact that you spend 10 minutes on toilet and 20 off, and get relatively few accidents shows that this has been achieved.

Now you're at the step where you need to transition towards asking independently for potty breaks. So you really need to start easing off the scheduled breaks to achieve that. Instead, watch him or get one of those alarms, anticipate that he needs to pee then prompt him through requesting potty and reinforce him for going on the toilet. Make sure these are powerful reinforcers.

It seems like what you're trying to do is stretch out the intervals of scheduled breaks to teach him increased bladder control...but you're also still giving him a diuretic diet (lots of salt and liquids). That doesn't seem like a reasonable combination. The goal is not to make him some sort of super child that can retain massive amounts of liquid, but rather to teach him to always want to void on the toilet and to request it independently. You need to focus on teaching him to independently request breaks, and then the time between bathroom breaks will increase when you lay off the liquids and salt.

If you and your husband are exhausted and need a break, it's ok to take a break for one day where you don't do the potty training diet. Just try to catch the accidents as (or better yet before) they occur. You've already done the step that really requires the diet, maintaining that now only helps to get the potty training done quicker...but if you're exhausted, it's ok to slow down.

As far as where you are in potty training, you're in the middle of the Azrin and Fox book, although since your child has limited verbal skills, you're also contending with the communication issues, which definitely adds another level of difficulty and complexity. Stick with it!