Tag Archives: autism and toilet training

Can You Toilet Train a Non-Verbal Child?

Parents of non-verbal children often delay toilet training, assuming that these kids need more communication skills to be successful.  I disagree.  I think children and their parents need other skills more.  Here are my thoughts about what really matters for these kids:

  • Their parents need excellent observation skills.  A child that cannot easily communicate their needs and concerns is still showing you signs that they have already eliminated or that they are ready to eliminate.  Children have familiar facial and postural changes such as grimacing, grunting, and crouching.  They often go to their “poopy place”, a location in the house where they prefer to have bowel movements. Behind the sofa is a common spot.  Just like typically-developing kids, parents who know when to anticipate elimination can guide their child to the potty so that kids make the connection between sitting and successfully eliminating.  This may mean that grazing and sipping all day long is over.  If drinks and meals are served generously but not continuously, it is easier to predict when a child will have a full bladder.  The act of eating often stimulates colon activity, so bowel moments are more regular and therefore predictable as well.  This is easier when meals are larger and eating is not happening in small snacks through the day.
  • Children need familiar routines.  When non-verbal children can anticipate a toileting routine, they don’t need to rely as much on receptive or expressive language skills.   For example, ending a meal and getting dressed will remind them that they now go to the toilet.  Lack of a routine will mean that they have to work harder on communication.  Being caught out of their routine and in need of a toilet could be so stressful that they resist giving up their diaper.  Create and carefully maintain  routines that support success and calmness around elimination.
  • Families need good toileting equipment.  A child that cannot describe in detail why they are uncomfortable is going to be less cooperative with toileting.  Beyond an appropriate potty or toilet insert/footstool set-up, a non-verbal child needs clothing that is easy to manage and wet wipes that really clean them.  My strategy of “dry runs”, in which children pretend and get a chance to practice, helps everyone see if they have prepared well for toilet training.

Help has arrived!  My book, The Practical Guide to Toilet Training Your Child With Low Muscle Tone, is now available on my website, tranquil babies and in a clothbound hard copy by contacting me through my site.  Read   The Practical Guide to Toilet Training Your Child With Low Muscle Tone: Help Has Arrived!  to learn how my innovative book is designed to be parent-friendly and help you move forward with toilet training today!

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Why Do Some Kids With ASD and SPD Refuse Toilet Training?

Toilet training is one of the few self-care skills that fall primarily on special needs parents.  Speech therapists, feeding therapists, occupational therapists and ABA instructors all do assessments and create plans.  Hints on toilet training from your therapy team are often very helpful, but “the boots on the ground” are yours as a parent.  You are the one that deals with it when *&%$ happens, as it most certainly will!

Many parents find themselves with children that do not cooperate or become defiant to the entire process of training, regardless of their level of cognitive, sensory or motor involvement.  A child with profound issues can cooperate well, and a child that is in a integrated class can be steadfast in not participating.  What gives?

  1. Sensitivity to multi-sensory input:  The noises, smells, even the lights in a bathroom can be mildly to very irritating to sensitive children.  They may not verbalize it, even if they have lots of language; they just want out.  Try to minimize what you can, and use the sensory calming techniques your OT has shared.  Ask for all her good ideas!
  2. Sensory seekers that aren’t motivated to remove wet or smelly diapers, don’t register the experience, or actually want to explore what is in that diaper.  Some children are at the other end of the sensory spectrum, and may not find the odor and feeling of a soiled diaper offensive or even that noticeable.   See Pull-ups do a wonderful job of reducing the sensory input, so try training pants with a leak-resistant cover. Just like a younger typically-developing toddler, some ASD and SPD kids “smear”, which is exactly what it sounds like: decorating the room and/or themselves with their feces.  This is a behavioral issue with older children, but it also suggests that the motivation to get trained isn’t going to include wanting to be rid of the diaper and it’s contents.
  3. They dislike being exposed to room-temperature air, and wiping/being wiped.  These kids probably have always dislike diapering.  They might avoid you after they have had a bowel movement to avoid being changed.  You may have had to become an expert in the “fast change” so that they are not totally hysterical.  Well, sitting on the pot with their pants off for a while and learning to wipe might be even harder than being diapered.  Try warming the room, get a warmer for the wipes (these exist) and make sure that you communicate that this doesn’t mean they have to sit there for a long, long time.
  4. They hate the feeling of the clothing sliding over their legs.  Time to work on reducing their tactile sensitivity.  It can be done; ask your OT.  And find some super-soft clothes for the toilet-training period.  Fleece shorts, anyone?
  5. Sitting on the toilet seat feels like they are perched over a big scary hole.  Children with poor spatial awareness or poor proprioception aren’t good at judging how large the opening is or how deep.  Add some instability with low tone, and you have a recipe for fear.  Then flush the toilet while they are still sitting, or standing nearby, and that potty seems like it could suck them down!  Try a potty seat and gradually move them over to a toilet once they are confident and independent there. Do more homework exercises on core stability and postural control, and don’t forget vestibular activities from OT.
  6. Without a clear sense of time, sitting there seems like it takes forever.  Kids can have no sense of how long something they don’t enjoy will take.  Use a visual timer, the microwave timer, or your smartphone timer.  My iPad has a visual countdown clock to see when time is up.

These are the most common that I have encountered.  Some of my posts on toilet training children with low muscle tone will also apply to kids with ASD and SPD, so check out  Low Tone and Toilet Training: How Your Child’s Therapists Can Help You  and Low Tone and Toilet Training: The 4 Types of Training Readiness.

The Practical Guide to Toilet Training Your Child With Low Muscle Tone is finally available! My 50-page e-book is for sale on my website  tranquil babies  (or buy a clothbound hard copy if you live in the U.S.) to help you with training.  Check out  The Practical Guide to Toilet Training Your Child With Low Muscle Tone: Help Has Arrived!  to learn more about my book and how I can help you navigate potty training without tears!

 

 

Low Tone and Toilet Training: Parents And Children Need To Work Together

This one is simple to explain, but not so easy to achieve with some kids.  Children whose interactional pattern is defiance or whining are going to be much harder to train, regardless of whether or not they have significant issues with low muscle tone.  In fact,  I would rather coach a very physically unstable but cooperative child than a toddler with mildly low tone but a firm commitment to resist any adult request.   If both parties aren’t able to work together, things may not go well.  At all.

Toddlers and preschoolers are known for their tendency to love the word “no”.  Did you know that, developmentally, the high-water mark for hysteria and the reflexive “no” is between 18 and 24 months?  Yup, that’s when language skills haven’t emerged to support expressing feelings and comprehending adult reasons. It is when emotional fuses are neurologically short, as in that forebrain is still sooo immature.   They really can’t handle their emotions at all on a brain level.  They have just left that sweet-baby phase where they want to please you more than anything, and they can’t be quite as easily distracted from bad behavior now.  This is a generalization, and there are some parents reading this that are thinking “We never got that lovely baby phase.  He went from crabby infant to bossy toddler!”  Well, I sympathize,  and I still invite you to read on.  All is not lost.  As language, emotional and reasoning skills slowly grow, a child who still falls apart easily and rages constantly isn’t always at the mercy of neurology as much as not having some basic coping skills.  It’s time to work on them before you jump into potty training.

Toddlerhood is long, all the way up to 5 years-old, and I won’t minimize the tantrums and agitation that can emerge.  This extended path to greater maturity is why I bought, devoured and constantly use The Happiest Toddler on the Block, Dr. Harvey Karp’s great book on building toddler coping skills. Half of the benefit is learning to both listen to and talk to toddlers in a way that calms things down.  I could not do my work as a pediatric occupational therapist with as much joy and enthusiasm as I have without these strategies.  Thanks, Dr. Karp!

For parents of children with language, communication or cognitive issues that result in developmental delays, your child may be 4 years-old but their other skills that are closer to 18 months old.  You can still toilet train.  Has your child been diagnosed on the autistic spectrum?  You can still train them.  Really.  The process may take longer and you may have to be both very creative and very consistent, but it can be done.  Job #1 is still the same: building a cooperative and warm relationship.

If your days are defined by defiance and whining, you need to learn all of the Happiest Toddler techniques that reduce frustration, including Patience Stretching and the Fast Food Rule.  Stretch Your Toddler’s Patience, Starting Today! You need to use “time-ins” for shared fun and warmth without a goal in mind.  You could try some of the more language-based techniques such as Give It In Fantasy and Gossiping.  And of course, you need to look at your approach to setting limits. All that love is great, but if your child knows that there are no consequences to breaking family rules or aggression,  your plan is in trouble.  Dr. Karp’s techniques aren’t intended to be a toilet training plan, but they set the stage for learning and independence.  Those are the ultimate goals of toilet training!

If you would like a more detailed or more personal level of support, visit my website tranquil babies  and purchase a consultation (in the NY metro area) or a phone/video consult!

 

Low Tone and Toilet Training: Transition to Using The Adult Toilet

Once the potty seat has been mastered, the question soon becomes: How is she going to use a regular toilet?  Most younger children use a step stool and an insert to sit securely on an adult toilet.  Kids with low tone often need a little more assistance to get up there and stay stable.

Here is what your child needs to be able to do in order for her to climb up and use a regular toilet with an insert:

  1. Have enough sphincter control to “hold it” while getting clothing and positioning right.
  2. Be able to manage easy clothing independently and have awareness of their needs for clothing management.  This means that if you have to tell them what to do or how to fix their clothes, they are not that independent yet.  Will you still help them?  Maybe, but if your child is able to know when her panties are down low enough, and a boy knows that he picked up his shirt before he pees, then your child can be a responsive participant if they find themselves unstable and need to think on their feet ( pun intended).
  3. Be stable while momentarily standing, either to manage clothing, while turning around, or for boys, to pee standing up.  Some little boys will pee in sitting for a long time, others (usually the ones with big brothers) demand the right to stand.  Aim is a lot harder if you are not standing in a stable position.  The handles on the following item give young children something to hold onto.  Just like seniors, grabbing a towel bar or the paper holder is a risk.  Every time they reach too far, their balance is altered.  That can be a huge help, compared to just a step stool.

 

41lLLbRbbkL._AC_US160_The best support with a step that I could find anywhere is the Mommy’s Helper Cushie Step Up Potty Seat.  There are a few available models with this basic design, but this one gets the best reviews for stability and ease of use.  If a set-up is wobbly with a typically-developing child, a child that has issues with safety and control in other situations is going to be in trouble as they climb up to use the toilet.  It doesn’t do as well with an elongated seat as a rounder one.  The contoured seat grips that tushie a bit more, and the texture and softness of the seat prevents accidental sliding as well.  This is not permission not to supervise for a while.  Kids are unpredictable, so a wobbly child might need your eyes just to see what will throw them off their focus and put them at risk of falling.

52733343312610pThe Baby Bjorn footstool is an amazingly stable choice.  The legs have rubber grips all the way around, and the top is super-grippy.  Even when wet!  It is hard to tip, and it is so sturdy that adults can stand on it without any problems at all.  Easy to clean too!  If your child can use a step stool instead of a ladder, this is the one.  Little boys that pee standing up will stand on this and hold the top of the tank or the back of the adult seat to steady themselves to aim.  The biggest problem for some kids is that sometimes it isn’t wide enough for the kids that normally stand with their feet very far apart (your OT or PT will call that a wide base of support in their progress note).  Their feet might go to the edges, seeking that same wide stance.  Not safe.  Practice having them standing on it without using the toilet, so that there are no surprises about how to climb and turn in a small space.

Remember, they have to get up there first, then pull down underwear and clothes.  Trying to climb stairs with pants around your ankles is asking for trouble.  Just try it yourself some day!  That means that clothing choice still matters.  Nothing with belts, long tunics or long skirts, tight leggings or skinny jeans.  Unless you want to do all the work and slow down their learning curve.

Hint:  Having kids develop independent dressing skills when they are off the potty, i.e. getting ready for bed, dressing to go to daycare, etc. is essential.  I started writing “important”, but that is not accurate.  It is essential.

These kids need chances to build smooth and fast movements under pressure.  The only way to get there is practice and learning from repeated opportunities.  Good teaching is nice, experience is better.  The more automatic and controlled a skill is, the less difficult it will be to execute it when rushing to make it to the potty.  Being able to manage clothing without even trying to toilet train is important.  If your low-toned child is miles away from getting on the big toilet, and you are reading this for future reference, then today’s goal might be for her to to help more with getting dressed.

Looking for more information on low tone and daily life skills?  Check out Low Tone and Toilet Training: Teaching Toddlers to Wipe and Low Muscle Tone and Dressing: Easy Solutions to Teach Independence.

My e-book, The Practical Guide to Toilet Training Your Child With Low Muscle Tone, is finally done!  You can buy it at Your Therapy Source (a great site for parents and therapists), Amazon.com or on my website, tranquil babies.  I cover all the prep you need to do for success, help you address issues like constipation and language delays, and even deal with the inevitable setbacks that arise along the path to independence.  Read more about this unique book at The Practical Guide to Toilet Training Your Child With Low Muscle Tone: Potty Training Help Has Arrived!

Wish you had someone to ask about toilet training a child with low muscle tone?  You do now!  Visit my website,  tranquil babies , and purchase a phone consultation to get personalized attention, and a chance to ask all your questions!

Why Low Muscle Tone Creates More Toilet Training Struggles for Toddlers (and Parents!)

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Most parents assume that toilet training isn’t going to be easy. A child with low muscle tone often crawls later, walks later, and may speak later.  But it can affect toilet training in ways both obvious and subtle.  As an occupational therapist, I wanted to share an explanation of why one of the consequences of low muscle tone can make teaching this skill just as hard as teaching your child to walk independently.  Hint:  it isn’t something you can see, and it isn’t balance or stability. (both important but quite visible consequences of low tone)

When muscles are not “sitting at the ready” for use as they are in normal tone, it takes more time, more stimulation, more effort or all three to get them to contract and tighten.  But it also means that the receptors inside the muscles of the bladder, the rectum, and the abdomen are not firing as frequently or as strongly.  The brain’s awareness of a change from resting state to stretched receptors is known as proprioception.  The special ed teachers I work with would call it “body awareness”.  This internal awareness of a change in pressure within your bladder wall, in your rectum and against your pelvic wall is what compels you and I to get up and go to the bathroom.  This is “interoception“, proprioception’s internal version.  With low muscle tone, your toddler is honestly stating the truth when they tell you that they don’t feel like they have to “go” and then they pee on the floor right in front of you.  They may have only a very weak sensation of fullness, or it may only be perceived a few moments before they really have to go.  That is what lower proprioceptive registration is like.  All of a sudden, the level of muscle receptor firing has reached a point where it is perceived.  And now there is a puddle on your floor.

What can you do?  Well, in previous posts I have mentioned that all the strategies to develop cooperation and frustration tolerance are keys to teaching a toddler anything at all. I go into more details about readiness in Low Tone and Toilet Training: The 4 Types of Toileting Readiness .  When you are facing an issue where the feelings that you are trying to sensitize them to are fleeting and invisible, you are going to need them to be very highly motivated indeed.  That means that you work on Happiest Toddler on the Block techniques such as patience stretching and “feeding the meter”.  These create positive parenting interactions that help your toddler listen to you when you tell them it is potty time and then keep them on the toilet long enough to make things happen.  If your toddler ignores your directions unless it is something he wants to do, and engages you in defiance games constantly just to see your reaction, you have some work to do regarding his behavior before toilet training is going to be successful.

Here are specific suggestions for toilet training the child with low muscle tone:

  • They need stronger physical sensations at the time when you sit them down on the potty. A full bladder stretches, and that stretch of the muscle wall is what they don’t feel unless it is a profound stretch. That means that they should drink a larger amount of liquid at specific times, so that bladder is really full at a predictable time. Yes, it means that roaming the house with a sippy cup will not work for toilet training.  A half-full bladder isn’t going to give enough sensory input but it will empty when they bend forward or squat.   If you have done the patience stretching and feeding the meter techniques from Happiest Toddler on the Block, your toddler can handle the change in beverage scheduling and they will be fully hydrated at all times.  They are just not drinking all day long.  The same thing can be done with meals, allowing for small snacks but having real toddler-sized meals, not grazing throughout the day.  Full colon= more contractions and more sensations.  A diet with fiber makes the poop firmer, and therefore sensations in the colon are more obvious.  A higher-fiber diet is a good way to prevent constipation as well.   This is a summary of a recent comment from a parent that used these methods:  She told me that using this strategy made her life so much less stressful when taking her daughter out of the house for preschool or appointments.  She knew that her child had fully emptied her bladder and wouldn’t be taking a big drink again until lunch.  She didn’t have to scout out bathrooms constantly and keep watching her daughter for little signs that she needed to “go”.  Makes sense to me!
  • Watch your child and see what their current voiding/defecating schedule seems to be.  Not every person is like clockwork, but you need to know when they are likely to go once you have the drinking and eating schedule down.  What goes in will come out.  Kidneys are more reliable than intestines.  About 30-45 minutes after a big drink, that bladder should be filling up.  For some children it can be 20-25 minutes. Then you know when to get them on the potty.  There is no point in sitting there when they are close to empty.  Everyone gets irritated.  Is your child unwilling to drink enough?  You may need to offer a better beverage, such as a yogurt drink or chocolate milk.  Serve them with a “silly straw” and watch that drink disappear!
  • These children just don’t have that much abdominal muscle tension to help with voiding, so the physical position they are in can help or hurt their efforts.  Sitting with your knees lower than your hips and your body leaning back reduces the intra-abdominal pressure.  You want to increase their ability to push gently, so sitting on a floor potty in a slightly flexed position can help them contract their abdominal muscles and push with their feet to get some pressure going.  Heavy straining is not recommended and so do not demonstrate or encourage superhero-sized force. Read my post on selecting potty seats that help your child do the deal. Picking A Potty Seat For Toilet Training A Child With Low Tone
  • Don’t distract them from the job at hand.  You might not be comfortable with a long conversation about toilet activities, but if they are chatting about Thomas the Tank Engine while that pee is coming out, they have no idea how it happened or what it felt like just before the stream started.  They missed out on becoming more aware of the sensory experience, and low muscle tone can make that sensation very fleeting and vague for them to begin with.  If they arrived on the potty full and ready to do their thing, this doesn’t have to be an extended bathroom visit.  This bathroom trip is all about the process of using the toilet, not a rehash of what they did at school that day.
  • Last, and probably obvious to most parents, is that you cannot shame a child for not recognizing a sensation that is not easily perceived because of low muscle tone.  They didn’t cause this issue, and once they are motivated to use the toilet, they would like to please you and feel proud of themselves too.

For more information about managing toilet training with low tone, take a look at Low Tone and Toilet Training: How Can Your Child’s Therapists Help You ?,  and The Ten Most Common Mistakes Parents Make During Toilet Training

If your child has mastered the potty seat but isn’t ready for the “big time”, read Low Tone and Toilet Training: Using The Adult Toilet for two pieces of equipment that can raise their game, and a few other strategies to help them make the switch to using an adult toilet.

I am so excited to offer parents a comprehensive manual that prepares them well and explains so many of the confusing situations that they encounter.  Don’t be afraid to train….be prepared!  Learn more how my book can help you make changes in your child’s skills today by reading The Practical Guide to Toilet Training Your Child With Low Muscle Tone: Help Has Arrived!

Here’s what parents are saying about The Practical Guide”:

The Practical Guide has truly been heaven sent!  Although my globally delayed 5-year old daughter understood the idea of toileting, this skill was certainly not mastered.  Our consultations with Cathy and her guide on how to toilet train have given me the knowledge I’ve needed to understand low tone as a symptom that can be tackled.  Morgan has made visible advances, and I am so encouraged and empowered because I know what piece we need to work on next.  Thank you, Cathy, for writing this book!”      Trish C, mother of Morgan, 5 years old

“I would often say to myself “Cathy has to put all of her accumulated wisdom down into a book”.  I am happy to say-here it is!  You will find no one with more creative and practical  solutions.  Her insights and ideas get the job done!”     Laura D. H., mother of M., 4 years old 

Cathy has been a “go-to’ in every area imaginable, from professional referrals to toilet training.  I can’t say enough positive things about her.  She has been so insightful and helpful on this journey.”  Colleen S. mother of two special needs children

How do you buy my book?  Three ways:  Visit my website tranquil babies, Buy it on Amazon.com, or visit your therapy source, a wonderful site for parents and therapists.

 

For even more support with your toddler, visit my website tranquil babies and contact me directly by purchasing a phone/video consultation.  

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Toilet Training Strategies for Children With Autism and Sensory Processing Issues

These strategies have worked for a wide range of children on the spectrum and/or those with sensory processing issues.  Every child is different, but the following techniques are the best I know for most families:

  • Time potty time about 20-30 minutes after meals and snacks.  The act of digestion and drinking should stimulate urination and bowel movements, and you might get results whether or not your child can respond to subtle sensations.  You can then work backward, and help your child connect the event with the sensation.
  • Know your toddler.  Most parents can easily identify when their child is ready to have a bowel movement by their expression or posture.  Some children duck behind the couch or stand in a corner.  Signs of urination are often more subtle, but wiggling while sitting or standing is a common one.  That’s the time to announce a trip to the bathroom!
  • What goes in on schedule will come out on schedule!   Avoid constant drinking throughout the day while training, and switch to only drinking at meals and during scheduled “drink breaks” through the day.  The goal is for you to be able to anticipate when his bladder will be full, and then have him use the toilet successfully 20-30 minutes later.  Connecting the sensation of having a full bladder and the experience of urination is easier this way.   This may be a big change for the child who carries around a covered cup and sips all day long, but once he is trained, you can go back to the “sippy life” if you wish.
  • Make sure that you have a plan, whatever it is, and know why you are doing it that way.  If you have a nanny or daycare provider, make sure that they know your plan and your rationale for it.  Children do best when they sense your confidence and support.  That doesn’t mean you cannot adjust things, but if you are just tossing new ideas out there every few days, it can be very hard for a sensitive child or one with limited modulation to handle all that change.
  • If your older toddler really struggles with control issues, and you suspect that they are resisting toilet training to establish their control rather than just struggling to learn a skill, then you need to address this first.  Establishing limits and building communication skills so that you are teaching more than begging is almost essential.  I suggest the Happiest Toddler methods to develop a strong alliance with you, based on mutual respect and cooperation.
  • Do not underestimate good positioning.  Toddlers that seek movement constantly, fear falling, or  those with a lack of stability all need to get their feet steady on either a stool or on the floor.  Some children with sensory issues can use the little rings over a standard potty, but it is more common for children with SPD to need more support.  They may not tell you they need it, they may just want to get off, not want you to leave them, or refuse to even hop up there.
  • If your toddler is often overexcitable or under-responsive to sensory input, he may have poor state modulation.  Your occupational therapist should be able to tell you if that is an issue for your child.  A nervous system that is idling too slowly isn’t registering the sensations of a full bladder.  The children that are overexcited will be paying attention to just about anything else.  Either way, use the techniques that work to create a more modulated state.  The Wilbarger Protocol, the How Does Your Engine Run activities, and more can help your child regulate their sensory arousal so that they can accurately perceive what is happening.

Remember:  independent toileting is a skill, and your child will develop this skill.  Think of all the skills they have acquired in the past few years.  This is the next one!

Sensory Processing Issues And Toilet Training Your Toddler: The Overview

Toilet training is never fun.  At it’s best, a sweetly cooperative child quickly connects urges with actions, and parents deal with an occasional accident.  In a few short weeks or months, you feel free to go anywhere without extra clothes, creme, wipes and diapers. Not when a child has difficulty processing sensory information.  Sensory processing difficulties do not prevent toilet training; they just make the training process much more complex.  The solution is to know what the typical toilet training strategies are, identify where your child needs more support, and create an environment that supports your unique toddler. Sound familiar?  If you have a child with SPD (Sensory Processing Disorder) or who has sensory processing issues related to developmental delays such as Down syndrome or Autistic Spectrum Disorder, your life is a series of these compromises and adjustments.

First things first:  know what the typical learning pattern looks like, so that your expectations can be reasonable.  “The Baby Whisperer Solves All Your Problems ” is my best resource book for a road map of toilet training through the whole toddler period.  I don’t know too many young toddlers with SPD that have finished training as early as her target age period, but it is helpful to know what she thinks signals readiness.  She also gives excellent studies of training gone wrong, with solutions, so that you feel that both of you can follow any mistakes with eventual success.

Secondly, you need to understand how your child’s sensory issues impact his learning.  Children with poor discrimination and relative insensitivity simply will not register the subtle physical sensations inside their bladder or the wetness in their diaper as strongly as other children.  They truthfully tell you they don’t have (any awareness of the need) to go.  Children who are very sensitive to touch may be very upset at being soiled and could find soggy or loose training pants very unsettling.  They may withhold just to avoid that sensation ever again.  Toddlers with poor postural control may be scared or even actually be unsafe on a loose seat placed over a standard toilet.  How could an adult  “let it go” after climbing up to a 4 foot high seat without no foot support and nothing but a removable ring to grip?  Poor modulators can get overwhelmed with the excitement of success, and poor auditory processing renders encouragement as confusing and stimulating but not instructive. Use all the techniques that have helped your child in the past.  Routines that create calmness, familiarity, and comfort, deep pressure or vestibular activities to stay alert and focused, and techniques that increase their general body awareness will help.  Develop a vocabulary around toileting so that they can explain their experience and can understand what your goals are. And timing.  Toddlers that are tired, agitated, or hungry are your worst students.  Toddlers that have had major scheduling or caregiver changes are stressed already.  Life is complex; you may have to create a calmer and more focused period to start training.

Next Blog Entry:  Specific Toilet Training Strategies for the Toddler with Autism and/or Sensory Issues