Thursday, May 3, 2012

Teaching Tate: wet or dry?

I think my least favorite part of being a mom was potty training. I probably should have taken my first two for counseling by the time I got them trained. I learned a lot though. A friend with several kids told me if I waited ‘til closer to age 3 then it would take 3 weeks to potty train verses months. The next three kids got to wait and it went so much smoother. When mom sets a timer and runs a toddler to the bathroom every hour whom is really trained? Is it mom or the toddler? 

Ironically, our adopted, Sydney, the one with no impulse control, was the easiest child I have ever trained. She caught on so quickly and loved staying dry. She had fewer accidents than the first six, by far. I doubt I had to change her sheets from a nighttime accident more than half a dozen times either.

Tate was definitely the hardest child for me to train. He just did not understand what I wanted. He was still wearing a drool bib when it should have been time to think about dragging out the potty chair. Our behavior consultant told me I would have to teach him the difference between wet and dry before I could make any headway. We started by holding his hand under water and talking to him about wet and dry. It didn’t take long until he understood what wet and dry were and he began to wipe his chin when it was wet. We lost the drool bib after a short time. Once he understood what wet verses dry was, he did better keeping his chin dry. Kids with autism often need to be systematically taught the simple lessons that typically developing kids learn on their own.

Once we were sure Tate could understand wet and dry, we began potty training. It was a very tough few months, and long after Tate was staying dry all day, he was still wetting the bed at night. Tate is my sixth child, so it was not the first time I had seen a wet bed but it did not just happen once in a while. It was every single morning. Changing sheets every morning for years gets old. Tate was too big for the largest kids diapers and trainers by the time he started school so he wore adult diapers to bed usually. The sheets were still wet every morning.

My wise husband was always insistent that we never try to teach a child with wet sheets by shaming them or using any negative reinforcement. He said “Do you really think a kid WANTS to wake up cold, wet and miserable? They cannot control it or they would!” Adding to a kid’s misery by letting them know how much they were inconveniencing their mother was not going to help.

Around age seven or eight, we talked to Tate’s pediatrician and put him on Desmopressin. It helps many kids but not Tate. We kept upping the dosage without great results and the medication was very expensive. Tate did wake up dry occasionally but almost never two nights in a row. I was beginning to think we would never make progress. Our behavior consultant often offered to help with ideas but I didn’t want Tate to feel pressured about the wet bed. I believed he had no control over it. After all, he had autism on top of inheriting the tendency to wet the bed. It was Shawn, the one who had taught me that a kid would not be wetting the bed deliberately who decided we needed to have a talk with Tate about his “problem.” I resisted. Tate didn’t have enough language to have much of “a talk” and he tried so hard to please us all the time. I worried he would not understand; but he would think we were upset with him and become anxious. Anxieties rule his life much of the time. 

I called the behavior consultant for advice. As always, she wanted data first. She is amazing and has taught me that data doesn’t lie. We took some data, including the bedtime and the time of waking. We know Tate wakes in the night and sometime lays awake for long periods of time, but now that he is older, I do not get up with him as I used to. Shawn’s idea was that we could teach Tate to get up and use the bathroom when he was awake in the night. It sounds simple. Don’t be fooled. Tate’s autism is hard to “fight” and routine means everything to him. He was used to wetting the bed at night. It was his routine.    

Normally, when trying to find the solution that works for a problem, we only change one variable at a time and continue to take data. This time we decided to change a lot of things at once and then remove one variable at a time to see what the effects were. Variable number one:  We had the big talk with Tate about trying to keep his bed dry at night. It went okay. So, we kept talking about it every evening before bed. Variable number two:  We took Tate off the medicine. It was so expensive and not really giving us the results it should have for the cost. Taking him off the medicine could have been counterproductive but we did it anyway. Variable number three:  We tried to monitor Tate’s intake of liquids in the evening. This was hard to police because he would get a drink in the upstairs bathroom if we stopped him in the kitchen. It has always been really hard for me to deny my kids a snack or drink (even in the night) if they say they are hungry or thirsty. Variable number four:  A chart Tate could use to keep track of dry nights. Tate loves charts and lists. They are pretty motivating in themselves. Variable number five:  Tate had to sleep in underwear instead of the adult-sized diapers he’d been wearing. Variable number six:  Gifts for dry mornings. There were HUGE gifts at first for even one dry night that were eventually sized down to smaller gifts for two nights in a row and then three nights, and then a week. Even the few bigger gifts ended up costing us less per month than the medicine had. 

We saw a little progress right away. We “played with” some of the variables and made some judgment calls almost immediately. The Depends were needed. Poor Tate didn’t get much sleep at all if he woke wet. He would not come downstairs and get us, no matter how many times we told him he should, so he would just lay awake miserable. He tried changing his own bed several times. He was sharing a room with a brother and it was interrupting both their nights. I only made a halfhearted attempt at controlling the liquid intake but Shawn was firmer about that one. We still watch it just a little. Talking with Tate, letting him chart his own progress, and the gift incentives seemed to make the biggest difference.  He is now out of the diapers and staying dry for weeks at a time, even without any incentives.

Tate, due to his autism, was stuck in the ROUTINE of bedwetting and he needed to be taught systematically NOT to wet the bed, as we had taught him everything else. I am so proud of Tate for learning these lessons that are so hard for him to learn! It was difficult to have a “talk” with Tate due to his limited language skills and his anxiety if we need to talk to him seriously about anything. (He always THINKS he is in trouble, yet very rarely is.) So, there you have it. Another milestone, late as usual, but I can mark that one off the list. Tate rarely wets the bed, at age 12. THAT was a long time coming.

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