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Fall 2002 Table of Contents
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Toileting Tips for Determined Parents!

By Leslie Fansler, Parent, Amarillo, Texas

When our son, Preston, who is Deafblind, was three years old he entered into the public school system's early childhood program designed for children with disabilities. We were blessed by having the most fantastic teacher in the world! Within a few months Preston was up, walking, and going everywhere. The teacher suggested that we start trying to toilet train him. I was skeptical, but we gave it a try. Here are some things we tried that worked, didn't work, and things we have learned.

First, we decided on a symbol for toileting for Preston's calendar box (I do not know why we didn't think about a symbol Preston would have chosen). We used an empty toilet paper roll, which was not really meaningful, as Preston didn't realize that an empty toilet paper roll is even tied to toileting! We were not having much success getting him to understand the whole toileting concept and sitting on the toilet was extremely boring, even when we piled toys all around it. He loved to play with balloons that were not quite fully inflated. He would sit for a long time and just play with a balloon, so we started giving him one to play with while he sat on the toilet. Bingo! It didn't take us long to figure out that a balloon was the BEST symbol for toilet for Preston. We began using it in his calendar box and he started looking forward to going into the bathroom to play with a balloon. We made sure that he never got to play with a balloon anywhere else, only in the bathroom. Preston began to have some success and we began to believe that he could be an independent toileter!

The next idea we came up with was a tactile path to the bathroom. I purchased heavy duty, tactically interesting material at an upholstery shop and sewed it together to form a long narrow pathway. We used this pathway to help Preston establish a route to the bathroom. At home we tacked it up on the walls, in the hall that approached our bathroom door. Preston would run his hand along the path as he walked to bathroom. At school they laid the pathway on the floor and he walked on it to go to the bathroom. He began to pair the pathway, the bathroom and playing with a balloon all together and decided that this was a fun routine. We could take the pathway with us anywhere so he always had a clearly marked route to a bathroom. This was extremely helpful when he was young and routes were confusing to him.

During this process his whole team, at home and at school, continued to work on his dressing skills so that he was able to handle his clothing in the bathroom. He still, even today, is unable to independently handle the fasteners on his pants, but I am sure that he will eventually master those skills.

TSBVI's Deafblind Outreach Team had spent time teaching us how to fade prompts so that Preston would not become a prompt junky. We used those techniques with the toileting routine. First we took Preston to the calendar box, where a balloon signaled the toileting routine, then down his pathway to the bathroom, on a schedule. Next we began to take him to his calendar box and to the beginning of his pathway. Then we took him only to the calendar box and he found the pathway on his own. Lastly, we just reminded him to go to the bathroom. Finally he reached a stage where we did not have to tell him; he just went to the bathroom on his own, without a prompt from us, or the calendar box. We no longer have to use the pathway or a balloon. Hey, we have made great progress!

Recently he was playing outside on the trampoline. He got off the trampoline, came across the backyard, in the back door, through the house and went to the bathroom, completely on his own!

Needless to say, we are extremely pleased to report that Preston is now toilet trained! In known environments he handles toileting himself. Wiping after a bowel movement is still an area we are working on. We are now teaching him to wipe every time he sits on the toilet, as he does not seem to understand that sometimes he needs to wipe, and sometimes he doesn't. We think it will be easier if wiping is always part of the routine.

These are things we have learned from Preston and this process. When you decide to toilet train a low-functioning child, be prepared to commit to at least ten years and really think through the toileting routine before you start. We made mistakes that probably added time to the process and confused Preston. It took about ten years to get Preston to where he is today, so just be prepared to make that long-term commitment. Many families try for a year or two then decide to wait until their child is a little older and try again. I think this is very confusing to kids. First I am expected to sit on the toilet, then I am not expected to and then at some magical date in time I am expected to again. We never quit trying after we got started, even though we were often very discouraged.

I do not believe in using pull-up type disposable underwear. It sends mixed messages to a child with cognitive difficulties. I am supposed to try and get to the bathroom, but if I don't make it that is all right because these pull-ups are similar to a diaper. We put Preston in underwear and he has stayed in underwear. There have been times when underwear have been a REAL HASSLE and pull-ups would have been MUCH easier, but Preston has ALWAYS known that it is not all right to wet his underwear.

Another thing we learned is that Preston loves to play in the water. When he soiled or wet himself I would immediately put him in the shower to clean him up. One of his teachers pointed out that this was a great reward for having a toileting accident. Now if he has an accident he has to clean himself up using baby wipes. That is not near as much fun for him. Pay attention to rewards and consequences during toilet training.

Toilet training a low-functioning child is not to be taken lightly, and is not for the fainthearted! It takes time, a strong commitment, a team effort, and great patience. A little stubbornness on the part of the adults helps immensely! I have had many parents ask me how we accomplished this, as they have not been able to and their older child is still in diapers. I always ask them to think about their child as an adult. Those of us who have low-functioning children will eventually have to think about adult placement. Preston's adult placement will be greatly enhanced because he is an independent toileter. It was definitely worth the commitment and effort!

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