My daughter is going on six years old and we are still struggling with getting her to use the bathroom and brush her teeth. Can you help? – Eddie
It sounds like your main concerns are self-care related. These skills can be challenging to teach to special needs children because they involve a lot of steps and are typically very non-preferred. Here are some ideas to help make these tasks easier.
Schedules: Try having your daughter go to the bathroom on a schedule. Start small with every 30 minutes. Keeping a schedule will help catch her before she has an accident and will give her more opportunities for success. In between bathroom trips you can flood her with liquids too and that will help ensure that she will actually eliminate into the toilet.
First-Then: use pictures to create a contingency for your daughter of using the toilet, and then doing something she enjoys. For example: First potty then iPad, or First potty then gummy bear. Visuals work great for this too!
Sitting on the toilet: If your daughter refuses to even sit on the toilet at this point you will need to start with reinforcing her for sitting, even if she doesn’t go potty. Have her sit for a small amount of time, maybe five seconds, then give her a special reward. Count out loud so that she knows she is almost done. Then next time try 10 seconds.
As she gets more and more comfortable you can have her sit for longer periods of time. It’s important to reward her for just sitting on the toilet, even if nothing happens. We need to teach her that the toilet is a GOOD thing.
Using the toilet: Once she is consistently sitting on the toilet with no problems, you will need to reinforce her only for actually using it. This means you will no longer give a treat for sitting, but only if she actually goes potty in the toilet. Make the reward for going potty BIG and special. This reward needs to be something she only gets for going potty; she can’t have it any other time. Edibles work nicely because as soon as the pee starts to come out you can pop a treat into her mouth.
Toys or electronics may also work. Whatever the item is, have it within arm’s reach in the bathroom during potty time. This is crucial.
The most important things when rewarding her for going potty are: First, rewarding her as soon as she goes potty. Do not wait for her to flush, pull her pants up and wash her hands.
No no no! Reward immediately, worry about the rest later. And secondly, the reward she earns has to be exclusively used for potty. If she gets the reward any other time it loses its power.
Visuals: Use a picture strip to help promote the steps of toileting.
Visuals: Use pictures to show her the steps of brushing her teeth. You can use cartoons, online pictures, or even real pictures of herself or family members doing the steps of teeth brushing. Focus right now on the important steps (like which teeth to brush), and worry about the less important steps (like how to put toothpaste on the brush) later.
Video Modeling: Another fun way to teach teeth brushing is through videos. Video tape a family member brushing their teeth and narrate the steps. “First mommy puts toothpaste on the brush. Next she brushes the bottom middle teeth for 10 seconds. 1, 2, 3…10. Next mommy brushes the top middle teeth for 10 seconds..” A video may make it fun for her and can help with memorizing the steps as she watches it over and over. Make sure it’s not too long, and keep it fun and entertaining. Have the person in the video really exaggerate their movements to make it very clear for your daughter what to do.
Practice: Practice is key!! Give her lots of opportunities to work on this skill and don’t worry if she doesn’t do it perfectly.
Reinforcement: Like with any new skill, we have to reinforce her behavior. Like I mentioned with potty training , you need to find a special reward she can only have for brushing her teeth. Since edibles won’t make sense to use in this case, find a highly motivating activity she can do even before bed. For example, maybe she can watch 10 minutes of a favorite TV show, or she can play a specific game on the iPad.
I hope these ideas help, and remember to be patient. Nobody learns a complex chain of behaviors overnight. It will take time and you will have to be consistent in rewarding her for trying. Best of luck!
Angelina works as a Board Certified Behavior Analyst, specializing in assessing and treating children and adolescents with autism, down-syndrome, and other developmental delays. She began her career in Applied Behavior Analysis in 2006, following her youngest brother’s autism diagnosis, and has since worked with dozens of children and families. She also writes a blog about her experiences as both a professional and a big sister. Her brother, Dylan, remains her most powerful inspiration for helping others who face similar challenges.
This article was featured in Issue 46 – The Time for Acceptance