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  • Welcome… My name is Debbie B. and I want to thank you for participating in today’s webinar. I am the author of Teach… My book is based on many years of experience as a toilet trainer working with special needs children. So, let’s get started.
  • Forget everything you have been told about toilet training I need to say this is a home program, not school. Use weekends and after school hours.
  • You may think the ideas you are about to hear are strange. But I’m telling you I’ve used it effectively and it works. In today’s webinar I will break down my method into it’s component parts, each step being small enough for your child to master.
  • Be flexible because your child’s individualality and personality is important, But your child’s age & developmental level is not.
  • Why is toileting so challenging for your child? Because it’s about change. It is not about purposeful resistance to Toileting. Change is very difficult
  • One of the things that makes my approach so different is that we are going to start in the kitchen to develop The skills needed for toileting.
  • Sitting for 5 minutes Getting to kitchen (compare)
  • A key to the success of my approach is understanding and paying attention to the importance of location. So there will be No more eating in front of the T.V. The most important point I am making here is that :Places have there purpose. (bedroom)
  • (question )Tell me where you change your child’s diaper when at home?? (changed diaper while standing on kitchen counter)
  • This is a learning process. You are now teaching your child to associate the place with purpose. (self-initiating) The end result is that your child must enter the bathroom by himself for a diaper change. That means no touching Or guiding him
  • This is not the playroom, it’s the bathroom
  • I think this is clear
  • You can place your child on the toilet for seconds- just until you get a clean diaper. You are not expecting your child to pee. All diapers should be in the bathroom, so remove them from your changing table or any other location
  • Make sure your child gets to the kitchen and bathroom independently before you move on. My message here is not to underestimate the importance of the pre toileting phase of my method. (Can tell-kid pees in the toilet-story about parents calling and thinking their kid is trained)
  • (don’t read) Don’t change your child every ½ hr. Any questions??
  • Does this sound familiar to anybody?? I am assuming that this is the main reason you are listening to me today Your child will not pee in the toilet Don’t worry, this works and you will be successful.
  • Before we get into my method tell me what you have tried? I believe the shortcoming of other methods is that they expect too many changes at one time. For i.e.. cold/hole, pull pants up and down, washing hands.
  • The success of my approach is based upon your child’s ability to hold his pee Until he gets to the bathroom. With my method, your child will learn to hold his urine for a long period of time. Then when he gets to the bathroom it will be difficult for him to maintain control and he will pee. So as far as holding time I have observed holding time increases as your child’s comfort level decreases
  • I have also observed that children will not pee close to a person. Therefore, you need to stay in your child’s Space, which will increase his holding time. I am sure this surprises you that your child will not pee next to you. (any comments?)
  • I have also observed that children will not pee in uncomfortable places. So our goal is to increase your child’s holding time and the way we will achieve this is by using places and Situations he finds uncomfortable to pee. I will make you aware of these places, so you and your child Can spend long periods of time in these places. Then when you get your child to the bathroom He will have no other choice then to pee.
  • So if your child doesn’t pee in uncomfortable places it is logical he will pee in his comfort places. Which is the place he feels safe being alone and spends most of his time. I can almost bet that it’s your couch. This also explains why you may keep your child on the toilet for hours and then he runs to the couch, computer and pees
  • You have forced your child to hold his urine for longer than usual. He really has to pee and will take any opportunity to run to his place to pee. So don’t turn away. (story about therapist) Stay in his space and hover over him Any questions??
  • You will witness your child’s amazing ability to hold his urine. Because your child is resisting change to a new place to pee. let me just say that you need to make sure you have enough time to carry this through. So be careful about not starting the waiting i.e. close to bed time. Because once you start each session you need to have the time to complete it. Or your child will Pee in bed. You need to be consistent for the entire process. From wait time to pee on the floor. It should not be interrupted. You don’t have to start a new session. Of course its best if you can, so you should try to start this on a weekend.
  • Bet you never heard of this step with any other method. You are pushing through change. He is learning to be comfortable Peeing in the bathroom, then the toilet. One step at a time First purpose and then place. Tell me your rxn to this point??
  • Parents must leave the bathroom
  • You will have to keep the door closed. Again, your child has to pee so bad that he will try to escape to his Usual comfort pee place. Questions??
  • Then take him out of the bathroom
  • You are now going to repeat this procedure, But you now need to increase wait time outside of the bathroom which will result in decreasing waiting time inside the bathroom. So if your child spent 1-2 hours in the bathroom before he finally peed, then for your next time, add that to waiting time outside of the bathroom. And of course the way you do that is to make him uncomfortable
  • When it’s down to just minutes before your child pees then direct him to the toilet.
  • You should now be very aware of your child’s behavior related to toileting. He has now made the association between place and purpose. He knows where to pee. So he can enjoy more time in his favorite places. Questions??
  • However, you should continue to encourage holding time by changing his setting. i.e. playing with same toys but different location The difference now is that your child doesn’t need to be watched as closely as before.
  • Your child is now very aware of the feeling that holding creates. He has adjusted to the bathroom setting and will no longer try to run to his old comfort places to pee. When it gets close to his pee time you do need to watch him and pay attention to his body language. There will be an indication that he needs to pee. Look for wiggling, a body/position stiffness, a stare, touching himself or anything that signal. Your child now knows where and when to pee but is still dependent on your direction. You need to gradually reduce your cues.
  • Take advantage of any outing. School, park, friends house, grocery store, restaurant, therapy session Bus- different seat Let me mention that if you are going to have company i.e. grandparents for the weekend. Then don’t start this New pet
  • Put chair to block usual place, probably a corner
  • Let’s review. I brought up some really unique ideas today.
  • MFA-Bialer

    1. 1. A Revolutionary Approach for Children with Autism Spectrum Disorders and Other Special Needs Absolutely Your Child Can Be Toilet Trained! Deborah Bialer
    2. 2. Before we get started…. <ul><li>Throw away your old ideas! </li></ul><ul><li>There will be no: </li></ul><ul><li>Dressing; </li></ul><ul><li>Toilet schedule, charts or journals; </li></ul><ul><li>Camping out in the bathroom. </li></ul><ul><li>Bribes/rewards </li></ul>
    3. 3. Get ready for new and unusual ideas <ul><li>Be flexible and keep a positive attitude throughout. </li></ul><ul><li>These ideas are unconventional and may seem strange. </li></ul><ul><li>Each small segment of this process will be accepted before you move to the next small step. </li></ul>
    4. 4. Developmental Level <ul><li>The developmental level of your child , including his form of communication is not relevant to this method. </li></ul>
    5. 5. Understanding Change <ul><li>Change is difficult and overwhelming. </li></ul><ul><li>The change to the location of the bathroom is difficult for your child, not purposeful resistance to toileting. </li></ul><ul><li>You will understand why your child will not pee in the toilet, yet pees any place other than the bathroom </li></ul>
    6. 6. Pre-Toileting Skills <ul><li>We will start in the kitchen to acquire the skills needed for the bathroom </li></ul>
    7. 7. Let’s Begin <ul><li>If a child cannot get to the kitchen to indicate hunger, he will never get to the bathroom to indicate that he has to pee </li></ul>
    8. 8. Readiness <ul><li>Sitting independently during meal times </li></ul><ul><li>Sitting for about 5 - 10 minutes with no restraints </li></ul><ul><li>Getting to the kitchen independently when hungry </li></ul>
    9. 9. Understanding Location <ul><li>The kitchen is for eating; </li></ul><ul><li>The bathroom is for eliminating </li></ul>
    10. 10. Change Diaper in Bathroom <ul><li>Only change diapers in the bathroom </li></ul>
    11. 11. The child must eventually get to the bathroom independently for a diaper change <ul><li>1) Establish the consistency of diapering in the </li></ul><ul><li>bathroom; </li></ul><ul><li>2) Encourage this verbally and show your child </li></ul><ul><li>the diaper; </li></ul><ul><li>3) Gradually reduce your guiding, touching or </li></ul><ul><li>holding hands; </li></ul><ul><li>4) Then expect your child to enter the bathroom </li></ul><ul><li>first, not follow you. </li></ul>
    12. 12. The bathroom <ul><li>The bathroom is for peeing, not for playing </li></ul>
    13. 13. Only One Change at a Time <ul><li>The bathroom is not the place to teach dressing </li></ul><ul><li>Don’t teach hand washing while teaching toileting </li></ul>
    14. 14. Toilet words <ul><li>Consistently use the same simple phrase. </li></ul><ul><li>For example, you would say, “John, toilet.” </li></ul>
    15. 15. Helping Make the Connection <ul><li>You can place your child on the potty/toilet for 10 30 seconds. Just while you get a clean diaper. </li></ul><ul><li>All visible diapers should be in bathroom </li></ul>
    16. 16. Pre-Toileting Goal <ul><li>Make sure your child has a firm understanding of location and the purpose of the bathroom before moving onto the next step </li></ul><ul><li>This may take a month or longer </li></ul>
    17. 17. Less is better <ul><li>You should do diaper changing procedure about every 2-4 hours or when you would naturally change your child’s diaper. </li></ul>
    18. 18. Resistance <ul><li>Most children with autism and related disorders resist urinating in the bathroom. Do the following scenarios sound familiar to you? </li></ul><ul><li>“ My child refuses to sit and pee; he just runs out of the bathroom and then pees on my couch!” </li></ul><ul><li>“ I made him sit on the toilet for hours and NOTHING. Then he ran to the computer and peed.” </li></ul>
    19. 19. Other Methods <ul><li>Want change too fast </li></ul>
    20. 20. My Method <ul><li>Holding time increases as your child’s comfort level decreases </li></ul>
    21. 21. My Method <ul><li>Children will not urinate close to a person </li></ul>
    22. 22. My Method <ul><li>Children will not pee in uncomfortable places </li></ul>
    23. 23. My Method <ul><li>Children will pee in Comfortable places </li></ul>
    24. 24. My Method <ul><li>Look away and he will run to his comfort place to pee. </li></ul>
    25. 25. Holding Time <ul><li>Once you take your child to the bathroom, you hope there is no more holding time possible. </li></ul><ul><li>Oh, but there will be! </li></ul><ul><li>Waiting time may be longer than expected </li></ul><ul><li>You will witness your child’s amazing ability to hold his urine. </li></ul>
    26. 26. Yes! Pee on the Floor
    27. 27. You Might Want to... <ul><li>Remove the rugs </li></ul>Use your larger bathroom
    28. 28. Leave me Alone! <ul><li>Children are fine in their own space. </li></ul><ul><li>Sometimes they get a little fussy. </li></ul>
    29. 29. Take a Peek
    30. 30. Be Happy <ul><li>Get ready to be happy as soon as your child pees on the floor! </li></ul>
    31. 31. Start to Adjust Your Bathroom Waiting Time <ul><li>After a few successful urinations on the bathroom floor, you need to adjust your bathroom waiting time. </li></ul><ul><li>Stay close </li></ul><ul><li>Use uncomfortable situations to extend holding times outside of the bathroom </li></ul>
    32. 32. Transitioning From Floor to Toilet <ul><li>When waiting time in the bathroom decreases to minutes, this would be the time to direct your child to urinate in the toilet </li></ul>
    33. 33. Concerns with Changes in Bowel Movements During Urine Training <ul><li>If your child holds his bowels for two to three days and this is an unusual pattern, then you need to put his diaper back on until he has a bowel movement. </li></ul>
    34. 34. Self-Initiating : This is Our Goal <ul><li>Increase holding time </li></ul><ul><li>Beginning— Child can do whatever he enjoys. </li></ul>
    35. 35. Self-Initiating: This is Our Goal <ul><li>Increase holding time </li></ul><ul><li>Middle — Child is away from comfort areas. </li></ul>
    36. 36. Self-Initiating : This is Our Goal <ul><li>Increase holding time </li></ul><ul><li>The last portion — You are completely in his space, hovering over him and keeping him away from his comfort places. </li></ul>
    37. 37. Take Advantage of Uncomfortable Places
    38. 38. Your Child Will… <ul><li>Adapt to a different bathroom </li></ul><ul><li>Be successful in all other situations </li></ul>
    39. 39. Bowel Movements <ul><li>Bowel movements are a separate skill. </li></ul><ul><li>• B.M. in pull-up in usual place </li></ul><ul><li>• B.M. in pull-up in bathroom </li></ul><ul><li>• Help with positioning to toilet </li></ul>
    40. 40. Conclusion <ul><li>Here is a review of the key steps that are involved as you “Teach Toileting” </li></ul><ul><li>Sits for meals </li></ul><ul><li>• Indicates hunger </li></ul><ul><li>• Independently gets to bathroom </li></ul><ul><li>• Comfortable/uncomfortable places </li></ul><ul><li>• Holding time increases as your child’s comfort level decreases </li></ul><ul><li>• Pee on the floor </li></ul><ul><li>• Transitioning from floor to toilet </li></ul><ul><li>• Self-Initiating </li></ul>
    41. 41. Conclusion <ul><li>Bowel movements are a separate skill. </li></ul><ul><li>• B.M. in pull-up in usual place </li></ul><ul><li>• B.M. in pull-up in bathroom </li></ul><ul><li>• Help with positioning to toilet </li></ul>
    42. 42. Conclusion <ul><li>Available for private consultation and discussion groups </li></ul><ul><li> </li></ul><ul><li>Available on </li></ul><ul><li>Deborah Bialer </li></ul><ul><li>[email_address] </li></ul>