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S2E51 - Toilet Training at 9 or 10? You're Not Alone—and There Is Hope for Older Kids · Play Therapy Parenting: Real Parenting Questions Answered by a Child Therapist

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  You're listening to the
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  Play Therapy Parenting Podcast with Dr. Brenna Hicks.
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  Hi,
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  I'm Dr. Brenna Hicks,
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  The Kid Counselor.
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  This is the Play Therapy Parenting Podcast where I give you insight,
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  awareness,
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  and enlightenment about your parenting
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  and your relationship with your kids.
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  In today's episode,
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  I am answering a question from Chelsea,
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  and this is actually pursuant to some of the
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  toilet
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  questions that I've answered.
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  So toilet training,
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  toilet issues,
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  toilet struggles.
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  And so this is a follow up question to some of those earlier episodes,
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  and this is about
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  her son who will be 10 soon
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  and is still struggling with toileting and so wanting some
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  solutions or some suggestions at the very least.
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  So Chelsea,
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  thank you so much for the email and I appreciate you reaching out.
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  So let me read parts of her email and then we'll dive in.
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  My name is Chelsea,
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  and I just recently found your podcast.
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  I saw this one on toileting and had questions.
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  I have a son who will be 10 next month who is on the autism spectrum.
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  I kept listening,
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  hoping for a new trick,
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  and I was left hanging because we took away diapers for the start of kindergarten,
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  much like this.
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  We thought it worked.
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  The accidents became more frequent over the years,
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  however,
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  and despite having him clean his own underwear,
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  it just hasn't worked.
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  He started hiding it in nooks and crannies around his room or in the bathroom,
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  or he'd throw it out entirely.
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  Sometimes what I found ended up with me just throwing it out because it was so bad.
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  This continued for years until I just stopped buying underwear over and
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  over and made use of insurance benefits to get him diapers.
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  But despite trying to keep on top of cleaning up after himself,
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  he will still hide dirty poopy diapers all over his room in the bathroom.
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  Sometimes he'll poop in the diaper and just not change it.
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  I've had to make it a daily thing to still check my almost 10 year old's diaper.
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  So ultimately the questions are now what?
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  What's next?
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  We have a therapist,
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  but while we've been trying to build rapport and not moved into any work,
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  we're required to move to another therapist soon.
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  So it's like starting all over and I really
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  just need something to start working with now.
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  I mean,
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  it's been obviously years.
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  Can I really be considered impatient?
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  Thank you for your help and thank you for this amazing work.
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  I appreciate any suggestions that you have.
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  OK,
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  Chelsea,
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  so.
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  I think it's probably most helpful to start with.
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  You are not alone.
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  There are so many parents in your exact same situation,
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  many
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  of whom I've worked with personally.
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  With 89,
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  1011 year olds still struggling with toileting,
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  still pooping in their underwear,
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  still struggling with what to do at night,
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  whether they're in pull-ups or diapers or underwear or the whole shebang,
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  you're not alone.
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  This is not an isolating scenario,
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  and even at 9,
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  almost 10,
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  many kids are still dealing with these issues.
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  So I feel like you just need a little bit of
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  reassurance that this is more common than you may think.
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  And
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  then here are my thoughts based on what you've
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  shared and based on your questions and your scenario,
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  you didn't mention it,
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  so I assume this has been done,
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  but I just want to be as thorough as possible.
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  In a scenario like this,
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  we have to rule out physiological.
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  Reasons,
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  so I suspect that you likely have,
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  but we need to make sure when we
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  have something that is beyond the developmental appropriateness,
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  we want to make sure that we rule out any kind of medical or physiological cause.
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  So if you have done that,
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  then these are my thoughts.
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  We know that kids have control over a handful of things.
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  And toileting is one of them.
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  We also know
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  in conjunction with that,
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  that kids who have high levels of anxiety
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  try to address and mitigate their anxiety
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  by taking control over things.
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  So I suspect your son has high levels of anxiety,
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  most kids on the spectrum do.
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  So there are high levels of anxiety,
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  and then there is a need for control
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  to address the feelings of fear
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  surrounding the unpredictable nature of life and the world.
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  And when you only have control over a handful of things,
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  toileting isn't easy.
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  Choice.
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  So in an attempt to mitigate anxiety.
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  And feel that he has some control over something.
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  I suspect this started as a natural response.
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  In other words,
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  he was feeling especially anxious for a stretch
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  of time potentially right after he started kindergarten
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  because the transition into kindergarten is so overwhelming for kids.
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  He has autism on top of it,
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  which probably made that transition even more difficult for a variety of reasons.
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  So diapers were taken away.
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  He felt completely anxious,
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  completely out of control over what did he have control?
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  toileting.
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  That was probably a natural byproduct of the circumstances of the time.
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  And unfortunately what happens is children become conditioned.
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  It becomes habitual
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  and it becomes something that they're not even cognitively processing anymore.
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  So I suspect probably now
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  this has just become so routine
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  and such a pattern of behavior
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  that it's just standard practice at this point,
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  so I don't even know if at almost 10
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  this is so much about control now as it is,
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  this is just how it's been for so long.
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  I'm in a routine.
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  So that may be a little bit of a light at the end of the tunnel,
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  Chelsea.
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  But you have to keep in mind that when you
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  have a highly anxious child who's grasping at control.
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  I suspect there's something about
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  going to the bathroom on the toilet.
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  That is too much for him.
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  Either it was at one point and he hasn't tested it in so long,
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  he doesn't even know if it would still be bothersome or overwhelming,
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  or it still might be scary to him.
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  Maybe it's the sensory piece of it.
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  Maybe it's that the toilet seat is cold.
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  Maybe it's that it's uncomfortable.
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  Maybe it's the sound of the toilet flushing,
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  maybe it's the sound of the poop hitting the water,
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  maybe it's the fact that the water splashes up.
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  Maybe it's the fact that the actual process of
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  elimination and the sensations that it causes are scary.
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  There can literally be hundreds of reasons
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  why a child has a spike of anxiety regarding bathroom
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  habits.
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  So I think one of the things that would be helpful
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  would be to start a desensitization process.
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  And here's what that will look like.
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  Maybe at first,
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  it's while still wearing the diaper.
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  He poops in the bathroom,
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  just in the room,
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  not anywhere near the toilet,
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  but
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  from now on when you need to go to the bathroom,
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  you're going to go into the bathroom.
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  Maybe that's just the first step
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  because it gets him out of his room.
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  It gets him out of hiding them in random places.
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  It gets him used to the idea of when I need to go to the bathroom,
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  I'm in the bathroom.
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  Then maybe the next step would be
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  still wearing the diaper,
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  but sitting on the toilet.
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  So maybe that's the next step.
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  And then there's a sense of,
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  OK,
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  when I need to go to the bathroom,
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  I'm on a toilet in a bathroom,
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  but I'm still wearing the diaper,
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  which is comfort.
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  That's,
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  that's normal.
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  So when we're changing things,
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  we're trying to mitigate too much change at once.
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  So even just sitting on the toilet is a step in the direction.
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  And then maybe it's
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  pooping without the diaper on,
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  on the toilet.
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  And depending on what the fear is,
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  depending on what the sensory is,
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  depending on what the reaction is,
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  you can adjust.
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  Maybe he needs a step stool for his feet
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  so that he feels more comfortable.
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  Maybe he needs toilet paper in the water
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  so that it doesn't splash or make as loud of a noise.
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  Maybe he does not want to be in the bathroom when the toilet gets flushed.
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  There are all kinds of scenarios that you can kind of assess,
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  but the process of desensitizing
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  is he becomes more and more comfortable with what
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  at some point probably was very overwhelming for him.
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  So the desensitization piece,
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  we're thinking about this in terms of anxiety.
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  This is the key that I'm hopeful is,
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  is landing,
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  but let me make sure that it's landing.
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  A lot of
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  adults,
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  and I've talked about adulthood bias.
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  We have a bias about
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  children and their behavior and their feelings and the way that they view the world.
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  A lot of adults would see this as manipulative,
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  a lot of adults would see this as obstinate.
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  A lot of adults would see this as defiant.
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  I believe that if we see this through a different lens,
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  which is
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  at one point he was overwhelmed by anxiety,
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  and he took control over something that he could
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  control because his life felt completely out of control.
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  Now potentially it's become a habit.
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  It's potentially become a pattern of behavior,
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  but that is undoable.
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  This isn't him trying to be difficult,
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  this isn't him trying to be manipulative.
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  This is,
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  this really scary thing happened.
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  This was the way I responded,
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  and now I'm just stuck doing it over and over and over again.
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  So if we see this as an anxiety-based issue.
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  We're able to address the anxiety and I'm so thrilled to hear that you're in therapy.
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  It's unfortunate that he has to start with a new therapist soon,
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  but he'll build connection,
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  he'll build relationship,
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  he'll build rapport,
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  and he'll be able to move into the work.
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  But in the meantime,
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  anxiety is something that can be conquered.
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  And if the child is given the time and the pace
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  of getting used to the idea of something that was once scary.
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  They're very resilient,
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  they can build coping,
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  they can handle things,
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  but it has to be done in a small step iteration kind of way.
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  So
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  you,
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  you create a time frame.
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  OK,
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  buddy,
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  so
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  come your birthday,
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  you said in about a month he's turning 10,
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  so maybe it's
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  birthday,
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  maybe it's Halloween.
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  What's coming up soon?
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  Come this date.
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  When you go to the bathroom
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  in your diaper,
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  you're going to do it in the bathroom from now on.
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  OK,
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  and that becomes routine and habit
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  and then at a future date you establish,
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  all right buddy,
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  on this date
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  you're going to start going to the bathroom on the toilet.
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  You can still choose to have your diaper on,
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  but you're going to sit on the toilet.
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  And if you are calm and consistent,
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  remember,
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  if this is an anxiety issue.
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  Anxious kids feed off of anxiety.
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  So you are calm,
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  you are regulated,
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  you are consistent,
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  you are predictable,
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  you enforce
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  the new normal.
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  If new normal is,
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  you're going to poop in the bathroom.
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  No matter what fuss,
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  no matter what tantrum,
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  no matter what meltdown,
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  no matter what screaming,
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  no matter what crying,
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  no matter what comes.
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  Survivor mode,
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  outwit,
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  outlast,
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  outplay.
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  One of you is going to give in,
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  it cannot be you.
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  Anxiety is built around oh no what if.
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  He needs predictability.
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  He needs stability.
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  He needs consistency.
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  So if you establish from now on this is the expectation.
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  You outwit,
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  outlast,
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  outplay.
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  And you just go into it thinking,
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  I don't care how bad this gets,
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  I don't care how long it takes,
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  I don't care what this looks like,
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  I will not give in.
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  And guess what?
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  He will eventually give in.
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  Because someone always does.
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  So that's the mentality when we're dealing with anxiety.
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  It is overwhelming to them.
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  It is paralyzing to them.
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  It is awful for them.
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  To be scared and anxious about something,
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  so we anticipate it's going to cause upheaval,
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  but we remain steady,
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  we remain calm,
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  we remain grounded,
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  and we fall back on the skills,
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  reflect his feelings,
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  give him choices,
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  use esteem building responses,
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  everything about the pillars that we've talked about,
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  all of the foundational components of the child-centered approach,
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  they will apply here.
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  And what you're doing is reassuring him and reinforcing that he is capable of this.
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  He's not going to be an adult still using diapers.
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  This too shall pass.
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  So the goal is that we provide the environment and the relationship
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  that will allow him to work through this.
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  So the relationship and the environment are the two most important factors.
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  Your neutrality,
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  your calm,
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  your regulation,
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  your consistency,
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  they matter.
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  So build yourself up just like you're going to tell him,
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  OK,
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  on this date we're making these changes,
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  you have time to acclimate to this as well.
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  Give yourself some pep talk,
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  make yourself believe you can do this,
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  get what you need in place
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  so that both of you will be successful,
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  but it truly is recognizing it as an anxiety
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  issue
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  that then manifested itself in control,
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  which now has likely become a pattern and a habit.
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  Pattern and habits can be changed.
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  And the desensitization process will be the easiest change for him.
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  So Crystal,
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  sorry,
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  Chelsea,
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  thank you so much for the,
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  the question.
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  I really appreciate it and I hope that that is helpful for many,
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  many of you,
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  not necessarily with an almost 10 year old,
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  but many,
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  many of you I know are in the throes of struggle with toileting.
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  So at the very least,
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  I'm sure that this resonated with a lot and I'm hopeful that you
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  leave encouraged and you feel like this is doable because it is.
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  All right,
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  I love y'all.
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  We'll talk again soon.
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  Bye.
• 13:58
  Thank you for listening to
• 14:00
  the Play Therapy Parenting Podcast with Dr. Brenna Hicks.
• 14:04
  For more episodes and just subscribe to our newsletter,
• 14:07
  please go to www.playtherapyparenting.com.