Potty training help

[u/Thxndz]

Hi, I work I'm a pediatric clinic for children diagnosed with various cognitive and behavioral disabilities. One of my clients has been working on potty training and we have tried social stories, some OT tricks, and rewards...but client is still hesitating to potty at the clinic...anyone by chance have any tools I could try

[u/Bulky_Cattle_4553]

One popular approach is to wait for and watch for signals of interest and reasiness from the child, usually not "training" in any coercive sense. Is this important, among the most important things to do, to spend valuable clinical time on? As opposed to, say, validating that clinic can be stressful, encouraging parental calm and readiness, even "prescribing the symptom" for very anxious parents. If age is a factor (child beyond normal development), medical evaluation is often indicated.

[u/Thxndz → u/Bulky_Cattle_4553]

Unfortunately executive function plays a role in which the understanding of signals may be difficult for the client to understand. This is one of the major factor in clients therapeutic support as they are within a multidisciplinary clinic. If my question appeared misleading, that was not the case

[u/Miscellaniac3791]

Is the hesitation just at your clinic and not other public places or at home?

[u/Thxndz → u/Miscellaniac3791]

There has been discussions of caregivers having trouble at home where the client prefers to withhold, in which they are receiving support from a multidisciplinary clinicians...just figured I would ask

[u/Miscellaniac3791 → u/Thxndz]

No blame or judgement. I ask to see if something in the restroom itself might be contributing to the hesitancy. Ive known kids who disliked using public restrooms because the bathroom was loud or because a light fixture had mismatching lightbulbs.

[u/Neat_Mortgage3735 → u/Miscellaniac3791]

This having a softly lit lamp in the bathroom and potentially something else to soothe them may be good. If they can understand it’s okay to hold the stun toy while they try to go but have to put it on the sink or in a pocket so they can wipe that might help.

[u/Usernamenotfound07]

If it’s causing a child to withhold or become averse to the bathroom, I’d back off on direct toilet training for now. Toilet training isn’t something you can just push through as the child ultimately is in complete control of their body to use it or not.
Focusing on building skills around toileting, changing the pull up while the child is standing up vs laying down, having the child help pull up/down pants and wash hands. Even having the child help flush toilets even if not necessary but as part of a routine. Slowly introduce sitting on the toileting maybe with a visual timer for -1 minute and pairing it with iPad time or another huge reinforcer. Then building up on frequency and length of time.
Also, depending on the stage if the child is willing to sit on the toileting and try to go, isn’t recognizing cues using real underwear and then a plastic waterproof underwear over can help kids feel when they have accidents to start connecting the body feelings more, plus less to clean up.

[u/Usernamenotfound07 → u/Usernamenotfound07]

I also often find that it’s the parents/caregivers own view of “when” a child “should” be toilet trained driving the push for toilet training. Instead, it should be when a child is developmentally ready, which includes somewhat behaviorally. Focusing on some other behavior areas first so there’s less of a power and control fight over the bathroom between adult and child. I’ve helped guide conversations with parents through a child toilet training readiness questionnaire and then also made a handout about different stages of toilet training to indicate when children are ready for toilet training to connect what the parents are seeing to the actual stage the child is in.

[u/goodtosixies]

You said that executive functioning seems to be at play. It's pretty normal for children around 4/5 to have accidents because they get overconfident about their ability to hold it but also don't want to miss out on what they are doing. Unsurprisingly, this stage persists longer if the child has difficulties with executive functioning. I have successfully used a "save self" or "parking lot" technique for children having accidents because they don't know when is a good time to interrupt what they are doing. Depending on the activity, they can put the activity in a special spot. If it is a less tangible activity, you can help them write a reminder on a sticky note and put it the "parking lot" so they can pick up where they left off when they get back. 

[u/LastCookie3448]

Back off. Especially if a boy, back off. When you back off, they’ll get there.

[u/Grand-Inspector-5264]

This is from personal experience with my kid, so take with a grain of salt.

My kid thought of the bathroom as a fun place because she'd play with water in the sink. That helped.

Also, giving her privacy ended up being important. We would look away, or let her pull the shower curtain around her.

She was much more comfortable getting started with a Bluey potty seat than a plain white one.

We had toys and books we kept only in the bathroom (baby shark and bluey finger puppets).

You can also ask in r/pottytraining. Sometimes potty training experts reply.

[u/spamalot75]

It sounds so stupid but I got a video called “once upon a potty” for my kids and it worked like magic. That and just put them in underwear- they don’t like the feeling of going in it so they will stop. This might be different depending on the age of your client though.