Potty Training Children with Special Needs

While parents often complain of difficulty potty training their children, for most families, potty training is a fairly easy experience. Even when there are problems or children show signs of potty training resistance, usually they will eventually become potty trained.

However, this is not always the case for children with developmental delays or disabilities, such as autism, Down syndrome, mental retardation, cerebral palsy, etc. Children with special needs can be more difficult to potty train.

Most children show signs of physical readiness to begin using the toilet as toddlers, usually between 18 months and 3 years of age, but not all children have the intellectual and/or psychological readiness to be potty trained at this age. It is more important to keep your child's developmental level, and not his chronological age in mind when you are considering starting potty training.

Signs of intellectual and psychological readiness includes being able to follow simple instructions and being cooperative, being uncomfortable with dirty diapers and wanting them to be changed, recognizing when he has a full bladder or needs to have a bowel movement, being able to tell you when he needs to urinate or have a bowel movement, asking to use the potty chair, or asking to wear regular underwear.

Signs of physical readiness can include your being able to tell when your child is about to urinate or have a bowel movement by his facial expressions, posture or by what he says, staying dry for at least 2 hours at a time, and having regular bowel movements. It is also helpful if he can at least partially dress and undress himself.

Children with physical disabilities may also have problems with potty training that often involve learning to get on the potty, and getting undressed. A special potty chair and other adaptations may need to be made for these children.

Things to avoid when toilet training your child, and help prevent resistance, are:

beginning during a stressful time or period of change in the family (moving, new baby, etc.)

pushing your child too fast

and punishing mistakes.

Instead, you should treat accidents and mistakes lightly. Be sure to go at your child's pace and show strong encouragement and praise when he is successful.

Since an important sign of readiness and a motivator to begin potty training involves being uncomfortable in a dirty diaper, if your child isn't bothered by a soiled or wet diaper, then you may need to change him into regular underware or training pants during daytime training. Other children can continue to wear a diaper or pullups if they are bothered, and you know when they are dirty.

More Potty Training Information

Once you are ready to begin training, you can choose a potty chair. You can have your child decorate it with stickers and sit on it with his clothes on to watch TV, etc. to help him get used to it. Whenever your child shows signs of needing to urinate or have a bowel movement, you should take him to the potty chair and explain to him what you want him to do. Make a consistent routine of having him go to the potty, pull down his clothes, sit on the potty, and after he is finished, pulling up his clothes and washing his hands.

At first, you should only keep him seated for a few minutes at a time, don't insist and be prepared to delay training if he shows resistance. Until he is going in the potty, you can try to empty his dirty diapers into his potty chair to help demonstrate what you want him to do.

An important part of potty training children with special needs is using the potty frequently.

This usually includes 'scheduled toileting' as outlined in the book 'Toilet Training Without Tears' by Dr. Charles E. Schaefer. This 'assures that your child has frequent opportunities to use the toilet.' Sitting on the potty should occur 'at least once or twice every hour' and after you first ask, 'Do you have to go potty?' Even if he says no, unless he is totally resistant, it is a good idea to take him to the potty anyway.

If this routine is too demanding on your child, then you can take him to the potty less frequently. It can help to keep a chart or diary of when he regularly wets or soils himself so that you will know the best times to have him sit on the potty and maximize your chances that he has to go. He is also most likely to go after meals and snacks and that is a good time to take him to the potty.

Frequent visits during the times that he is likely to use the potty and fewer visits to the potty at other times of the day is another good alternative. Other good techniques include modeling, where you allow your child to see family members or other children using the toilet, and using observational remarks. This involves narrating what is happening and asking questions while potty training, such as 'did you just sit on the potty?' or 'did you just poop in the potty?'

Even after he begins to use the potty, it is normal to have accidents and for him to regress or relapse at times and refuse to use the potty. Being fully potty trained, with your child recognizing when he has to go to the potty, physically goes to the bathroom and pulls down his pants, urinates or has a bowel movement in the potty, and dresses himself, can take time, sometimes up to three to six months. Having accidents or occasionally refusing to use the potty is normal and not considered resistance.

Early on in the training, resistance should be treated by just discontinuing training for a few weeks or a month and then trying again. In addition to a lot of praise and encouragement when he uses or even just sits on the potty, material rewards can be a good motivator. This can include stickers that he can use to decorate his potty chair or a small toy, snack or treat. You can also consider using a reward chart and getting a special treat if he gets so many stickers on his chart.

You can also give treats or rewards for staying dry. It can help to check to make sure he hasn't had an accident between visits to the potty. If he is dry, then getting very excited and offering praise, encouragement, and maybe even a reward, can help to reinforce his not having accidents.

Another useful technique is 'positive practice for accidents.' Dr. Schaefer describes this as what you should do when your child has an accident and wets or soils himself. This technique involves firmly telling your child what he has done, taking him to the potty where he can clean and change himself (although you will likely need to help) and then having him practice using the potty. Dr. Schaefer recommends going through the usual steps of using the potty at least five times, starting when "the child walks to the toilet, lowers his pants, briefly sits on the toilet (3-5 seconds), stands up, raises his pants, washes his hands, and then returns to the place where the accident occurred." Again, although you are trying to teach him the consequences of having an accident, this should not take the form of punishment.

While it may take some time and require a lot of patience, many children with special needs can be potty trained by the age of 3-5 years. If you continue to have problems or your child is very resistant, then consider getting professional help.

What is Lovaas Method

What is the Lovaas method?

The Lovaas method is an early intensive behaviour therapy approach for children with autism and other related disorders. It is also known as the UCLA (University of California Los Angeles) Programme by Dr Lovaas, Home-Based Behavioural Intervention and UCLA Model of Applied Behavioural Analysis as developed in the Lovaas Institute for Early Intervention.

It is based on extensive clinical experience and research carried out over more than 30 years by psychologist Dr O. Ivar Lovaas, in the USA.

In the late 60s and 70s Lovaas worked with institutionalised, non-verbal children who had been diagnosed as autistic. He concentrated on verbal communication using the strategies of applied behavioural analysis.

At the time Lovaas' work was criticised by colleagues advocating the psychodynamic approach, because most of the children lost their verbal skills when the programme ceased and they returned to institutional life. However, those who moved back with their parents, who wanted to be informed about the treatment, did much better. This led to an increased importance of the role of parents in the education process.

Lovaas went on to work with younger children, aged two to four, in their home setting with parents involved in the treatment to see if he could ensure that the new skills learned were maintained. Children received 40 hours a week of structured input on a one-to-one basis from trained students whose work was closely supervised by Lovaas and his staff.

The results were published in 1987 and caused great interest as up until then there had been no studies to show that behavioural strategies could present such positive results.

Lovaas compared three groups of 20 children:

1. The experimental group of children who received 40 hours a week of treatment.

2. A first control group who received 10 hours behavioural treatment together with a variety of treatments from other sources such as those provided by small special educational classes.

3. A second control group who received no behavioural treatment.

Lovaas described his findings from the experimental group as follows:

a) A recoverable group of individuals, who, following intervention, no longer demonstrated the characteristics of autism. Lovaas claimed that 47% of children who worked 40 hours at home per week achieved normal functioning by the time they successfully entered full-time mainstream education at the age of seven.

b) An intermediate group (40%) who made substantial progress but who still displayed autistic characteristics. Many of them retained language difficulties or an intellectual disability.

c) A small number (10%) who received little or no benefit from the intervention.

The results also showed that those children who followed the programme for two years or more gained on average 30 IQ points compared with the other two groups who made no IQ gains.

A follow-up study carried out by McEachin, Smith and Lovaas in 1993 indicated that the majority had maintained their gains into adolescence. They appeared to be functioning normally and at blind interviews with clinicians were said to be indistinguishable from children with no history of autism.

What does the programme involve?

Lovaas and his colleagues recommend that treatment should begin as early as possible, preferably before the child is five years old and, ideally, before the child reaches three and-a-half years. This is necessary in order to teach basic social, educational and daily life skills. It can also reduce stereotypical and disruptive behaviours before they become established.

The home-based programme consists of 40 hours a week of intensive therapy. Results of Lovaas studies show the importance of maintaining these hours in order to maximise the benefits to the child. The therapy is on a one-to-one basis for six to eight hours per day, five to seven days a week, for two or more years. Teaching sessions usually last two to three hours with breaks. The intensity of the therapy means that there is usually a need to establish a programme team which normally consists of at least three persons. These people have all undergone a full training programme.

Family participation is a very important element of the treatment as researchers at the time found that skills learned in clinics and special classrooms would not transfer to a home setting unless there had been parental involvement in the child's treatment programme. All skills are broken down into small tasks that are achievable and taught in a very structured manner and accompanied by lots of praise and reinforcement. Examples of reinforcers are small bites of food, play with a favourite toy, social rewards such as verbal praise and hugs and tickles. Gradually food and other artificial reinforcers are replaced, if possible, by more social and everyday reinforcers. Aggressive or self-stimulatory behaviours are reduced or replaced by ignoring them or by introducing more socially acceptable forms of behaviour.

The intervention programme progresses very gradually from teaching basic self help and language skills to teaching non-verbal and verbal imitation skills, and establishing the beginnings of toy play. Once the child has mastered basic tasks, the second stage teaches expressive and early abstract language and interactive play with peers. In more advanced stages of the intervention the child can be taught at home and school.

Behaviour modification

Behaviour modification is based on the fact that pleasant consequences can promote good behaviour and unpleasant consequences, such as punishments, can reduce unacceptable behaviour. In the 60s and 70s aversive procedures had been used by behaviour analysts of all sorts when alternative treatments had failed and if the behaviour of the client was dangerous to himself or others. For this reason behaviour modification has been criticised. In his early work Lovaas defended its use in situations when a child used self-injurious or self-stimulatory behaviours. He contended that aversive procedures constituted no more than 1% of the typical interactions in his programme and that they are not generally required after the first few weeks.

The UCLA project no longer employs physical aversives and there is more of an emphasis on positive reinforcement procedures.

What are the benefits?

Lovaas and his colleagues believe that with early intervention a sizeable minority of children with autism and related disorders are able to achieve normal educational and intellectual functioning by the age of seven. For those children who do not achieve normal functioning it is claimed there are usually substantial decreases in inappropriate behaviours and acquisition of basic language is achieved.

There have been numerous articles and critiques written on this topic over the last 20 years and many arguments as to the validity of Lovaas' findings.
The treatment is extremely long and intensive and can therefore prove to be very expensive. However, a growing number of parents have used this method and have been pleased with the results.

In recent years there has been renewed interest in the Lovaas method following the publication of Let Me Hear Your Voice, Catherine Maurice's moving account of her use of the Lovaas approach with her two children.

Lovaas Method of Teaching Autistic Children

In my Mind - Aspergers Boy talks about how it is to be one

This is about a teenager with Aspergers talking about how it is to have the condition.











The Geek Test

1. do you have any special interests that could be described as obsessive? yes - often rarely never

2. do you have an interest in fashion? always often sometimes rarely - never

3. do people consider you a loner? yes - often occasionally rarely never

4. are you good at planning ahead for the future? rarely - never sometimes often always

5. were you good at sports in school? always often sometimes rarely - never

6. do you have any problems making friends? always - often sometimes rarely never

7. have you had problems with passing job interviews? always - often sometimes rarely never

8. do you suffer from depression? always - often rarely never

9. did you have any speech difficulties as a child? ie, delayed speech, language delay, needed speech therapy yes no

10. do you feel that others do not recognise your full potential and intelligence? yes - often occasionally rarely never

11. were you bullied in school? often - sometimes rarely never

12. is your imagination unusual, with unique ideas that others don't have? often sometimes rarely never

13. do your eyes focus on patterns in objects without trying? yes - often occasionally rarely never

14. do you find it easier to e-mail someone than talk on the telephone? always - often occasionally rarely never

15. do you enjoy the status of having a new car/new stereo/new tv? always often sometimes rarely - never

16. do you find it hard to cope if people enter your personal space? always - often occasionally rarely never

17. are you good at reading body language? always often occasionally rarely - never

18. do you find it hard to describe your feelings and emotions? always - often sometimes rarely never

19. do you like to tap, rock, or chew something at idle moments? always - often occasionally rarely never

20. do you ever find people confusing when they talk to you? always - often sometimes rarely never

21. do you enjoy busy bars and clubs? always often sometimes rarely - never

22. do you like to collect items to make a set? always - often sometimes rarely never

23. are you more happy when in a group than being alone? always often sometimes rarely - never

24. do you like to work out how something works, eg.computer, telephone, or radio? always - often occasionally rarely never

25. do your friends mean everything to you, above your hobbies and interests? always often occasionally rarely - never

26. have you ever been thought of as eccentric? yes - often occsioanlly rarely never

27. would you like to live on a desert island with few people? always - often occasionally rarely never

28. do you like to be spontaneous and change routine often? always often occasionally rarely

29. do you enjoy meeting new people in everyday life? always often occasionally rarely

30. would you rather answer a question bluntly and truthfully than have to lie? always - often occasionally rarely never

31. do loud noises bother you? always - often occasionally rarely never

32. is your style and image very important to you? always often sometimes rarely - never

33. is your sense of humour different from the mainstream, or considered odd? yes - often occasionally rarely never

34. do you get very focused on an activity and forget the world around you? always - often occasionally rarely never

35. do you get emotional when you read a sentimental birthday card? always - often sometimes rarely - never

36. are animals more comforting to you than people? always - often sometimes rarely never

37. do you prefer romance/drama films to science fiction/documentary films? always often sometimes rarely

38. does hot weather make you uncomfortable? always - often occasionally rarely never

39. do you prefer not to wear any/hardly any jewellry? always - often occasionally rarely never

40. have you ever felt scared in a social event? always - often occasionally rarely never

41. would you enjoy being in a big crowd, such as a football game? always often sometimes rarely

42. do you enjoy word games and logic puzzles? always - often occasionally rarely never

43. as a child did you love to play house, dress up, and similar games in a group with other children? always often rarely

44. have you had difficulty in finding a partner/relationship? often occasionally rarely never

45. do you talk to friends most days of the week and weekends? always often rarely

Autism and Me

Autism Features

Here is another Autism Video.Its clear in this video how to recognize CWA.The stacking of any item,the fleeting eye contact,etc.

Skills Involved in Commun ication

In order for us to effectively communicate, we need skill in multiple areas, including (A) verbal and (B) non-verbal arenas.

(A) Verbal/Spoken Communication Skills (may or may not be affected in ASD)

• Semantic language: The ability to use and understand words, phrases and sentences; including abstract concepts and idioms. Aspects of semantic language include:

Receptive verbal language: The ability to understand spoken words and ideas.

Central Auditory Processing (CAP): A mixed group of abilities needed to process and derive meaning from sounds and words; including the abilities to distinguish between similar sounds, and to pick out the main voice from background. In short,“what we do with what we hear.”

Expressive verbal language: The ability to express our ideas with spoken words.

Articulation: The ability to speak each word clearly.

(B) Non-Verbal/Non-Spoken Communication Skills (Problematic in ASD)

• Urge to initiate shared social interaction and two-way communication: Theory of Mind

The ability to socialize/relate/empathize requires a working “Theory of Mind.” Theory of mind refers to the relatively unique ability of humans to understand: (1)that I have a mind, (2) that you have a mind; and most importantly, (3) that our minds may not know or be feeling the same things. Without a theory of mind, there is little point in communicating. After all, who would you be communicating to? There is limited ability to truly recognize that there is another human being in the room. It will be difficult to feel the need to communicate with anyone else. It may seem as if there is a plane of glass between the child and others. Eye contact will be poor.

With limited ability to “get inside your mind,” it will be frequently difficult for the child to demonstrate empathy for what you are feeling. For example, a child with theory of mind problems may assume that since he is happy, then you must be happy; or the child may not understand that someone else is deceptive when his own mind always attempts honesty.

Thus, the ability to recognize that you have a mind, the ability to relate to that mind, and the ability to empathize with that mind are all parts of the same skill. It is felt that theory of mind problems underlie many of the difficulties seen in the Autistic Spectrum Disorders.

Closely related to the “interest” in social communication (that arises from a working theory of mind) are the following skills. They are required to actually achieve the meaningful interaction. Certainly, if you don’t have these skills, your ability to appear interested in social interaction may become blunted.

• Pragmatic language: The practical ability to use language in a social setting, such as knowing what is appropriate to say, where and when to say it; and the give and take nature of conversation. Effective pragmatics requires a working theory of mind: the ability to figure out what the other person does or does not already know—or might or might not be interested in hearing about. Examples of pragmatic language/theory of mind problems would be:

A new student moves into the school district and enters the classroom for the first time. The teacher asks him where he comes from. The Autistic Spectrum child responds: “From the hallway.”

As an Asperger’s child walks into the office, the doctor notices that her pink shirt matches the color of her jacket. He jokes, “If you change into a green shirt, does the color of the jacket change, too?” The child responds: “My wardrobe includes a turquoise shirt, not a green one.” This child’s spoken language is precise, but she misses (1) the actual meaning of the question; and more importantly, (2) misses that the whole purpose of this conversation was just a little fun chit-chat to initiate an interaction.

• The skill to know what is—and what is not—important

Ability to see the big picture rather than fixate on details.

Ability to maintain a full range of interests.

• Symbolic play skills
• 
  

Give a child a yellow box on wheels, with thin long black strips on it. The ability to understand that this object actually represents a school bus is a type of communication—just like the ability to recognize that the letters “C-A-T” stand for a furry animal. Both involve the use of symbols rather than the actual object to communicate.

By 18 months, most toddlers start to use objects as symbols for something else. For example, a cup is for drinking, but it also makes quite a handy telephone. By 3 years of age, most children are quite good at “let’s pretend” activities, such as “You be the cowboy!” The toy school bus is not fascinating because the cold metal box can move, but because little toy figures chat while getting on it as they go to school. Stuffed animals are not just warm rags of cloth to drag around, but living creatures that have feelings and needs.

So, by 18-36 months of age, typical children make continuous progress in the skill of appreciating the representational meaning of a toy, rather than focusing on its straight forward visual attributes. Failure to develop representational/symbolic/pretend play is a strong marker of the Autistic Spectrum Disorders. After all, if you cannot understand that a physical toy bus represents a real truck, how could you understand that the even more purely representational sound “bus” represents a real truck.

• Non-verbal (non-spoken) transmission of language. The simple sounds are not the only thing my body sends through space when it attempts to communicate with you. It also transmits:

Facial expressions

Body language

Tone and prosidy of voice

• Associated skills sometimes also involved with language problems:

o Motor (muscle) coordination, including both gross and fine motor.

o Spatial orientation.

O Overall cognition

Secondary Problems Resulting from Failure to Understand

If the child does not understand what is going on around her—especially if pragmatic/socialization cues are difficult—secondary problems usually occur in the Autistic Spectrum Disorders. The child will frequently appear:

· Anxious, since she doesn’t know where the next blunder will come from.

· Insistent on sameness and showing ritualistic behavior. Change means that previously hard-learned strategies will not help in this situation. These kids are barely hanging on. One new wrinkle can throw them over the edge. For example, Jill may know how to unpack her lunch from her backpack each day; but, what happens if the lunch is missing. Now what do she do?

· Inattentive, since it’s hard to pay attention to something you don’t understand.

· Rude-appearing, since she doesn’t understand rules of conversation such as waiting your turn.

· Interested in objects rather than people. After all, objects are more predictable.

· “Hanging back” from peers, for all of the above reasons, and from simply not knowing how to make conversation and relate.

· “Out of it” and “odd” looking