1. Toilet Training on the Spectrum Presented by Kristyn Peterson

2. Is It Time? Setup For Success ABA Methods Troubleshooting Developmental Deficits In Practice Resources Questions

3.  Does my child feel uncomfortable when his/her diaper has been soiled?  Does my child try to find a private space to have a bowel movement?  Does my child generally have bowel movements in a familiar environment?  Does my child generally have bowel movements on a regular, predictable schedule? Is It Time?

4. Setup for Success  Expose your child to underwear before beginning the toilet training process.  Make the toilet a part of your routine  Take the novelty out of bathrooms  Saturate your environment with “potty” things  Get the materials you need

5. ABA Methods  Set a toileting schedule  Check pants (“Are your pants wet or dry?”)  Keep track of successes and accidents  Sit on the toilet for at least 2 minutes each time  Reinforcement! Reinforcement! Reinforcement!

6. Pros and Cons of ABA Method ProsCons Very structured for childrenTime-intensive Structured for parents so they know how to adapt program for their child Requires a great deal of commitment Individualized for each childRequires a lot of preparation before the beginning of toilet training Heavy emphasis on reinforcement

7. Troubleshooting: Accidents  Accidents happen to all kids, not just kids with developmental delays.  Patience is key!  Accidents are a learning opportunity!

8. Punishment for Accidents can lead to…  Decrease in intrinsic motivation to use the toilet  “Holding it” for fear of being reprimanded or punished  Child may forcefully relieve themselves to exhibit power over the toilet training process

9. Troubleshooting: Bowel Movement  Will likely take longer than urination training  What can I do to help the process?  Take your data!  Figure out the root of the problem  Use what your child is already doing as a spring board  Relaxation techniques  Remember to make it a positive experience!

10. Troubleshooting: Flooding *Flooding should be used with extreme caution, and only if a child has been unable to have a urination success in at least 2 weeks since the beginning of potty training.*

11. Dealing with Developmental Deficits From Sensory Defensiveness to social skills, and everywhere in between

12. Developmental Deficits: Sensory  Sensory Issues that come with potty training may include:  Tactile Defensiveness  Auditory Issues  Olfactory Issues  What can I do to help the process?  What is causing the sensory disturbance?  Make a plan that targets it from multiple angles

13. Sensory Examples Shawn is having a hard time potty training because the sound of flushing the toilet makes him upset. He anticipates this sound, which makes him not want to enter the bathroom at all.

14. ` Developmental Deficits: Communication  May not be able to tell you they need to go, have negative behaviors, etc.  What can I do to help the process?  Visual supports  Sign Language  Augmentative communication so they can initiate  Be aware of your child’s cues

15. Developmental Deficits: Social  Social skills deficits can impact toilet training  What can I do to help the process?  Teach in a way that they relate to  Social Stories ®  Comic Strip Conversations ®  PowerCards ®

16. Developmental Deficits: Rigidity and Routine Dependence  For children who thrive on structure and routine, toilet training can serve as a major upheaval in their world.  What can I do to help the process?  Picture schedule or checklist  Time chart  Use a timer

17. Developmental Deficits: Undesirable Behavior  Toilet Training can spur a lot of undesirable behaviors, like:  Aggressions, tantrums, screaming, self-injurious behavior  What can I do to help the process?  Try to always stay positive or neutral, not negative  Be calm, patient, and sympathetic  Help child realize that having these behaviors doesn’t get them out of the task

18. Developmental Deficits: Self-Help Skills  Many children on the spectrum have self-help skills deficits.  What can I do to help this process?  Practice these skills not just during potty time  Teach them by themselves  Make it fun and motivating  Remember the overall goal!

19. Developmental Deficits: Low Motivation  Low motivation to toilet train can be difficult to overcome  Intrinsic v. Extrinsic  What can I do to help this process?  Change up your reinforcement  Use what already motivates them  Use other reinforcement techniques  Give reinforcement IN the bathroom

20. Toilet Training In Practice: Public Places  Toilet training while you’re at a family or friend’s house or out running errands can be frustrating and stressful.  What can I do to help this process?  Bring smaller versions of any cues you use at home  Take your child to the bathroom first thing  Practice makes perfect!

21. Toilet Training In Practice: Overnight  Look at times your child goes, and take note if they wake up with a consistently-wet diaper  What can I do to help this process?  Invest in a plastic mattress cover (you’ll be glad you did)  Refrain from liquids an hour before bed  Always try to use the toilet right before bed and right after wake up  Only do as much as you need to

22. Toilet Training In Practice: Pull-Ups ProsCons Decreases amount of clean-up after accidents May make it harder for the eventual transition to underwear Pull-ups are readily available May provide unclear expectations Might be a more comfortable transition from diapers May become dependent on pull-ups, causing the need for a “second potty training” Throw away, rather than washing Social stigma may occur for older children Potty training can be done anywhere

23. Resources: Websites 1.ARASAAC.org ~Symbols to use for schedules, potty cues, etc. 2. Healthychildren.org ~Run through the American Academy of Pediatric. ~Info on toilet training. 3. TheGrayCenter.org/socialstories ~Information on Carol Gray’s research based Social Stories and Comic Strip Conversations

24. Resources: Useful Products 1.Huggies Cold Alert Pants—various pkg sizes ~Gives a cold sensation when the diaper is soiled 2.“Potty Time” video from Signing Time - $22 (on Amazon) ~Comes with DVD and CD with all of the songs from show 3.Potty Training Doll – around $25 (Amazon, Walmart) ~Comes with it’s own potty, feed it water, and it can model urinating for the child 4.Tinkle Targets – $9.95 Set of 30 (leapsandbounds.com) ~Fun shapes (rocket ships, etc.) for boys to use to aim for standing up

25. Resources: Useful Products 5.Color-Change Tablets – Vary in price (on Amazon) ~Some change color when the come in contact with urine, others dissolve immediately in water. 6. PowerCards book - $16 (Amazon) ~Instructional book on how to make PowerCards. By Elisa Gagnon author and primary researcher. 7.Potty Training Printables – Free from Toastwithcheese.com ~ Potty training schedules, checklists, and other visual supports

26. Comments or Questions? Email: Kristynpeterson1@gmail.com Kpeterson@kotm.org Web: kotm.org toastwithcheese.com Phone: (801) 221-9930 ext. 219

27. Thank you!