It’s Not If, It’s How and When

Source: Foundation Quarterly, Winter 2002

Jeffrey Cohen

Toilet Training In Less Than A Century

Potty training: two words that strike fear in the hearts and minds of all parents of children with fragile X. The neighbor’s kid did it at two and they can’t stop talking about it. Your older child did it at three and your nephew from Cleveland did it at four, all by himself without any prompting. But your son or daughter is five, no six, seven, or maybe even ten or twelve and still shows no interest. This is beginning to get embarrassing and depressing. What’s a parent to do?

Let me first tell you that I’m not a doctor, a psychologist or a behavioral specialist. I’m just a parent of children with fragile X. My thoughts are based on my own personal experience, consultation with many “experts,” reading, but most importantly on common sense, creativity, “thinking outside the box,” and a passionate desire to relate to, interact with, and help my child. In other words, tools that we all have.

First, avoid the mistake that so many others make when interacting with our children.

Just like typical kids are all different, so too are all kids with fragile X. They don’t all learn the same way or at the same pace and often different and creative approaches are required to learn new skills. The point is that whether you use the approach detailed here or elsewhere in many other good resources don’t feel like you have to follow the instructions to the letter. Nobody knows your child better than you. Nobody knows how they learn, what can grab and hold their attention, when something is working and when something isn’t. After reading this proposed method and any others you find, sit down and really think about how you can modify and adapt the procedure to fit your child.

In our case we started with resources that are often recommended: “Toilet Training in Less Than a Day” by Nathan Azrin and Richard Foxx, and “Once Upon a Potty” video-both checked out from our public library.

The book recommends using a doll as a role model and we decided right away that would be far to abstract for our son (4.5yrs) so we decided that I would be the role model.

Before reviewing the procedure,  first a word on when to begin this process. Remembering again that I do not have a medical or psychological background, I believe that when you are able to interact successfully and have fun with your child, on their level, thatThe procedure calls for
all the salty snacks they
can eat followed by all
the liquid then can
drink. The idea is to
keep the bladder full at
all times to maximize
opportunities.
it’s a good time to start. What I’m talking about is based upon what I still believe was some of the best advice I ever received from any professional about my son. He was evaluated by a psychologist at about age 4 before we even had the diagnosis of fragile X. At an early session he put my son and I in an empty waiting room with a hidden camera to watch us interact. Some toys, chairs, magazines and a tall corn plant,  that was it. I tried to get my son to play appropriately with the toys but he had has mind set on that corn plant. Batting at the leaves was to be the activity of the day and I had to decide whether to fight it or play along. I decided to play along and thus was born the “corn plant game”.  He’d bat a leaf, then I. He’d bat two, then I’d bat two. Pretty soon we were taking turns, setting the rules, laughing, interacting and having a great time. The psychologist loved every minute of it (the plant could be replaced) and explained that my son and I had stumbled onto what he thought was the secret of reaching him regardless of the diagnosis. Don’t try to forcefully pull him out of his world, go in there with him and begin the interaction on his level with an activity of his choosing. Begin a pattern of interaction and turn taking and eventually the transition to more appropriate activities and interactions will follow.

As it turns out this guy was right on the mark. This was the first of many great games to follow. The “lumpy couch” game and the “jumbling three of anything” game are two that come to mind. The activity was chosen by my son and then we made a fun, laughing, turn taking game out of it.

Which brings us back to potty training. The basic method was to take the procedure from start to finish and break it down into small component parts. Getting up off the couch, walking to the bathroom, opening the door, turning on the light, pants down, sit and go. Each activity is done by the role model and then the child. The book said use a doll for a role model but in our case I was the doll. I exaggerated every step and turned each into the kind of game my son and I frequently played. We took turns getting up off the couch and doing each successive step and when my son took his turn and completed each step he was greeted with absolutely wild praise and glee. He loved it. For actual successes we had a celebration fit for a king’s coronation.

The procedure also calls for all the salty snacks they can eat followed by all the liquid they can drink. The idea is to keep the bladder full at all times to maximize opportunities. After a success, when you’re back on the couch watching the video, check the pants. (Dry pants inspection game.) If they’re dry it’s time for more wild celebration.

Have plenty of underpants on hand for accidents.

Each time one happened he had to change himself and put his dirty laundry in the washing machine. Accidents also set up another game: the walking through the route to the nearest bathroom from the location of the accident game.

In between all this merriment keep the pretzels and pop flowing and watch the video about potty training. No other videos or TV. No other topic for the day or in our case for the entire weekend. It might even be a good idea to let your other kids sleep out. From the time we woke up on Saturday to the time we went to bed on Sunday this is all we did-and it worked. After 2 days we were

75-80% complete. The procedure finished gradually over the next 6 months but we never went back to diapers.

Keep a close eye and continue to heap wild praise for success with dry pants inspections.

You might feel a bit silly about all of this and if you’re embarrassed pull the shades. But to succeed you’ll need to tap into your inner child and have a good time with it.

My wife and I still laugh out loud every time we re-tell the story.

Now you know what they say about “always” and “never” so results in every case cannot be guaranteed, but I strongly believe that with the right mix of perseverance, creativity and unbridled fun it’s not a question of if, only how, and when. Good Luck!