An Idea Whose Time Has Come

A quote from one of Joy's daycare reports:

Potty: Sat on the potty after AM snack. Diaper was damp, so didn't think she would be able to go. But she sat. After a few minutes I asked her if she was all done. She looked away from me and within 30 seconds she was peeing. When she was done, she reached for the TP. Cool!

This quote was from April 2007. Joy was not yet three years old.

At age 6, she's still in diapers around the clock.

When it comes to toileting, the sliders and switches on Joy's mixer board (my favorite metaphor for her developmental pattern) have turned on, and then turned off again. As her words have repeatedly come and gone, so has her willingness to make beginning steps toward potty training.

It's been very hard to decide about making an all-out effort to get the toileting truly underway. I'd really been dreading any approach that involved panties and letting the accidents happen. I'd been rocked on my heels by the experience of datri over at Opposite Kids, whose Kayla was unswayed by an all-out four-day diaper-free marathon over the winter holidays.

One complicating factor for us is that most of the advice about toileting readiness for neurotypical kids has not been consistent with Joy's trajectory. Consider this list at BabyCenter.com:

• Can sit down quietly in one position for two to five minutes. [In our dreams!]
  
• Can pull his pants up and down. [With support - this one we've got]
  
• Dislikes the feeling of wearing a wet or dirty diaper. [Our sensory-seeker doesn't mind at all, might even like it]
  
• Shows interest in others' bathroom habits [Nope.]
  
• Gives a physical or verbal sign when he's having a bowel movement such as grunting, squatting, or telling you. [Oh, come on... you can tell when infants poop!]
  
• Demonstrates a desire for independence. [Hmmm... a little, maybe]
  
• Takes pride in his accomplishments. [Yes, but maybe not how they think]
  
• Isn't resistant to learning to use the toilet. [Totally off-and-on]
  
• Is in a generally cooperative stage, not a negative or contrary one. [Again, off and on. Those switches flip very fast.]
  
• Can follow simple instructions, such as "go get the toy." [Can, yes. Does? Maybe.]
  
• Understands the value of putting things where they belong. [In a few limited situations]
  
• Has words for urine and stool. [Not even.]
  
• Understands the physical signals that mean he has to go and can tell you before it happens or even hold it until he has time to get to the potty. [Only the one "kee" incident.]
  

The bits about being resistant/cooperative have been a big part of what's standing in the way about making a commitment to do anything more than sit potty in the evening before bath. For quite a while Joy was willing to sit on the pot and happily flip through a board-book or two. But then a few months ago she started physically resisting as soon as I would ask her to potty-sit -- and this kid can put up some powerful resistance, let me tell you!

Fortunately, Joy's intensive-therapy folks, Agency 2 (serving up their own House Blend of therapy combining behavioral and relationship principles), have a nicely flexible approach to toilet training.

What has come together in the past weeks has been a combination of readiness on the part of both Joy and her parents, and the willingness of Agency 2 and Joy's awesome-daycare-lady Lynda.

• Joy is often dry overnight.
  
• She's willing to drink a lot of water when we push it.
  
• She understands "first/then" and is willing to work for a relatively immediate promised reinforcer.
  
• Kindergarten is coming up and we want her to have this learning underway.
  
• Agency Two's training guidelines have the flexibility and willingness to "schedule train" without making the frustrating commitment to do a diaper-free boot camp approach.
  
• Lynda is happy to combine our goals for Joy with her daycare's standard potty-schedule routine

Following the Agency 2 recommendations (which are proprietary so I can't post the helpful document online, sorry!), we first did some thinking about desirable rewards that could be reserved for potty encounters, in a hierarchy of desirability. Then we spent several days after we got home from the lake trying to record the state of Joy's diaper every half hour. One important switch here was moving from having Joy in a onesie round the clock to wearing just T-shirts and elastic-waist pants. Onesies are delightful for preventing diaper-digging, but not so fine for moving toward toileting independence. The schedule-recording didn't actually reveal a lot in the way of pattern, but it did get us into a toileting schedule mindset, and pre-shadow for Joy that there was going to be more attention to diaper-related activities soon to come.

Then we sat down with our senior Agency 2 therapist and talked about initial goals, to get us and therapists and Lynda all on the same page. We decided on a schedule of a potty-run every 1.5 to 2 hours, in which Joy would help pull her pants down, clamber up on a footstool to sit on the toilet (with insert), sit for a nice slow count of ten, and then get a reward! Then she has to cooperate with re-diapering (generally standing up, at home anyway), pull up her pants, and work through a hand-washing routine.

We started on Saturday. So far, we have succeeded in getting through all the steps, including the ten-second-sit, every single time. As a side benefit, Joy is learning to count to ten, and is especially eager to fill in the "teh" when we get as far as nine. Sometimes she's in a mood to sit quite a while longer, though, if she's excited to play with her ribbon-reward or mylar-balloon-play reward.

And yesterday morning she woke up dry, was willing to play an interactive people game for a while after the count of ten -- and did a most excellent potty-pee.

I don't imagine this will be either quick or easy, and surely we'll be dealing with sliding switches for years to come. But finally it does feel like we're on our way.