What is one of the main parental concerns in an IEP? Toileting... no more pull-ups! Wait... my SPED 101 didn't teach anything about that.... Unfortunately, "Here's an M&M... go pee please." hasn't been working. Here's a toileting plan that I have used, and that actually works!
1.Stay in the bathroom or stall….for a looong time. (I've been in there literally all day) until you can reinforce successful urination in the toilet. But don’t make it aversive. Bring an iPad, toys, snacks (gross I know…) to motivate the student to stay in the vicinity of the toilet and not hate it.
2. Bring a favorite drink. More liquid means more opportunity for success with less wait time.
3. Bring a timer. Don't sit on toilet the whole time. Let the student move around the stall. Have students sit for a short time on the toilet, but frequently. Use the student as your guide. If you notice that when sitting for around 10 seconds they are getting antsy or unhappy, start setting the timer for 5 seconds and have the student get up before that happens. Try to end the “sitting” before agitation or elopement.
4.Find a very individualized reinforcer and have it handy to immediately reinforce success. This can be anything- what is your child/student's absolute favorite thing. Use this!! Playing in water, a favorite song/video, the trampoline even (huge right.. I know,) bubbles, a portable fan, a flappy toy...
5.Go pants-less. Why? So as soon as you see urination, run to the toilet, finish in the toilet, and immediately reinforce. Don’t make the child sit on the toilet indefinitely and wait for success. Ouch- toilet seat ring!
6.Reinforce urination by leaving the bathroom. But, don’t stay away too long. Come back in 20 mins. or so… and keep pushing the fluids.
7. Always model and prompt how to request to go to the bathroom. Use AAC, a bathroom picture/object, etc… Teach kids how to request even if they don’t have the verbal skills to do so. Have that picture/object readily available everywhere (in your pocket, on their schedule, next to the door.)
8.Ditch the diaper/ pull-up immediately. Get lots of underwear and clothes... and a mop. Kiddos need to feel that they are wet and be a little uncomfortable.
9. Accidents happen. Don’t reinforce or provide consequences for an accident. It is just that… an accident. If you are completing an activity, finish it. Then go change clothes. Talk about what wet means. "Uh oh… looks like your pants are wet. See wet."
- When changing clothes, have the students do as much of the changing as they can independently. Take your time and have the students put in the time, effort, and work to change. This is a natural consequence (having to change wet clothes) but it shouldn't be aversive. Don’t let the kids get frustrated…. have students request help as needed and practice teaching the skill of dressing.
11. Fade the reinforcer When the kiddo is "holding it," staying dry, and going less frequently give the reinforcer less.
- Less time (1 minute instead of 5)
- Pair genuine praise with the reinforcer so you can get to a point where you don't have to provide the reinforcer every time.
- Delay the reinforcer- get it after leaving the bathroom or upon getting back to class.
Good luck!! I would love to hear if this works for you!