a bit of a WWYD? problem solving.........

[devientenigma]

DS has been out of school for over 3 year, in that time I have since toilet trained him, however the last 6 month he's wet the bed a few times per night, every night. His anxiety levels are still high though not as high as when he was in school. There is less demands on him and he doesn't do no where near as much 'stressful' stuff as he did when in school. When I do try to get him to do things that could be even slight pressure he threatens to wet or dirty himself, more often than not, it's not a threat. DS won't go back to nappies (huge issues around changing) and why should he, though he won't use a public toilet. In fact half the time he hasn't even left the car. What do I do about using it and the night time??

TIA x

Ds's psych does desensitization to public loos stuff with him. And he has to clean up after himself if he dirties or wets. We have to carry on the desensitization all the time, so visit lots of public loos even if he won't go in the cubicle etc -just to hang out...

Not sure if this is practical for you? Your ds is more complex, I think.

His referral for mh service was based on getting the continence under control - not sure if you have contact with an appropriate outreach service? They visited ds at home initially, but he now manages to exclusively go to appointments at the clinic.

Well he's learned along the way that it's one thing you can't ignore, so it gives him power. Can you try a strategy where you take plastic bags with you and some tea towels. Then adopt zero tolerance. If he wets or soils, he goes straight back to the car, sits on the towels which are on top of the plastic bag (to protect the seat), you drive home and he changes, no drama, at home. To work, it would need absolutely no attention for him, so no talking about it, no reaction, just matter of fact.

What kind of things are you trying to get him to do Dev? Does it involve leaving the house?

thanks everyone, lol zzzzz.

Yeah Claw, it's if it's something he can't/won't do out of the house or if Iv'e managed to get him the car, it's because of what's happening or needing to get out of the car.

Last night for example we managed a drive in movie, no need to get out of the car. We were one of the 1st to arrive so I could get an accessible space in case I had to leave suddenly etc etc. I managed to pacify him for over an hour, however in that time came all the threats. DH offered to carry him to the toilets etc, again it was anxiety etc taking over or his avoidance strategies kicking in. Wasn't till the movie had started and DH said he could smell him, however he sat anxiously watching the film. Still demanded his drive (reward/his fun) etc BEFORE changing!!

My mam said she can't understand how he can control his body enough to threaten and do. I'm at a loss. He won't go back to nappies and using public loos is a long way off.

thinking about it, I know this is an issue of a bigger problem and it could be a catch 22, you need him out the car to go to the toilet but he's doing it in the car before you get him out, some tasks don't even require him to get out of the car??

Any more ideas welcome x

"Still demanded his drive (reward/his fun) etc BEFORE changing!!"

Only if you let him!

You do the driving. It's an ideal consequence. We can't go for a drive because we need to change you, isn't that sad?

That sounds great zzzzz.

Honestly Lougle he's a league of his own, why shouldn't he get his reward, after all he had done what we wanted, which was the drive in movie.

He's clever devient

If he poos in the car and you cant get him out, you have to drive home, which gives him his reward of driving in the car. Very clever.

No more demands are put on him because you simply have to go home to change him.

You have to admire him in a way

Sorry I know that is absolutely no help at all and it must drive you round the bend.

"why shouldn't he get his reward, after all he had done what we wanted, which was the drive in movie."

Because...because he took deliberate action which stopped him getting his reward. You aren't stopping his reward. He is. If you truly believe it is a conscious action, then he can consciously stop it. The only way to achieve that is to make the reward more compelling than the avoidance.

If you have a moral dilemma with that, and I can see you do, then how about his reward being 'a drive' but your condition being 'we go to the drive in movie and you don't do a wee or poo in your pants?

That way, he knows that if he follows through with his threat, he loses the thing that is dear to him.

partly because he doesn't work or think like that Lougle. He is not bothered if he has to do without as long as the demand isn't on him. What I was trying to say is that it didn't bother him that he had done it.

Yes Ineed he is clever, manipulative even, good at not doing much.

Which when your faced with anything he does, your at a loss, hence the profs loss too.

devient the fact that you got him to get out of the house is massive I know that causes him huge anxiety and that you struggle to get him out so that wont help his levels of anxiety, if he'd not had his drive which I know he likes the chances of getting him out if you wanted to would be harder again so in my mind you did the right thing there.

I know some kids with ASD have real problems with hand dryers due to sensory overload I'm also aware that he is older but can you get larger potties or similar if so you could possibly take him somewhere discreet until he's ready to tackle the next stage of using public toilets.

Yes it is manipulative, it is the most difficult thing to deal with.

Dd1 wasnt motivated by rewards at all, once when she drew all over the walls of her room I said if that happens again there will be no swimming this week. She said "I dont care I will go next week!" she was 5, another time I told her off she looked me right in the eye and wee'd on the floor, while staring at me.

I have been reading about PDA, I bought the book to find some strategies for Dd3 but it is like reading about Dd1.

As I said I have absolutely no idea how you will stop this and I really feel for you, clever, manipulative, anxious children are very hard to live with

Be kind to yourself

Its a tought one, in a way he is similar to dd2 (if you take away his reward/take away his treat it doesnt make a bit of difference). We have problems with public loo's, today i almost lost dd2 in toys r us as me and dd1 went into the loo's and dd2 made a quick exit . I would just take it slow with the public toilet thing, there are some nicer big disabled loo's that you could start with.

It seems though that the main problem is him using soiling/wetting to his advantage (to get out of doing whats expected of him), if it was me i would probably ignore it as much as you could (obviously you will need to change him at some point) but not make any fuss (dont say anything), i know it must be tricky as he's to old to change in the car so you either have to go home of coax him out of the car into a disabled public loo (which isn't easy).

I know its slightly diferent but dd1 used to make her self sick if she didn't want to do something, was horrid and stoped us going out for a while, in the end i was told to 'not make a fuss, clean her up and cary on', she carried on doing it until one day (whilst she was wretching) i said to her 'if your sick then you have to clean it up', she wasnt sick and hasnt done it sinse (luckily the thought of cleaning up her own vomit was enough to stop her doing it again). Trouble is all our dc's are different and what works for one may not work for another .

sorry but I don't think he will see this as some kind of power struggle, that if he does this....this will happen and he wins!!
it is probably the only way he can control something, it is so hard for young people with severe sn to control anything. so I would work with him on it.
I won't post my strategies on here as they are private to my dd(but feel free to pm me devientenigma)
tbh it sounds like he is making great progress, and I would give in a bit, short drive......then change him.

I agree with threesocks, I think it's tied in with anxiety/control etc, and sounds like you have so much to work on with going out of the house that that is a more pressing issue than the toileting.

I am thinking over time if the confidence is built up in going outside his safe zone of home/car slowly then perhaps the method of control will wan as his anxiety becomes less?

Example ds hiding for years in cupboard, under table furthest point, end of field refusal to come in and roaring. All this business at school was to deter him going into an environment his anxiety couldn't cope with. He knew I would be called and he would be removed from that and taken to his safe zone of home.

Now he doesn't use that control as he has built up trust that nothing bad is going to happen?

Your ds has just started to go out, coped with a film, went out to eat etc. social life and trust is far more important to you all and I am thinking the rest will follow x

A bedpan sounds a good idea perhaps when he has built trust in himself to step out car still take him with you to a public loo even if just to wait for you. Just wash your hands or something so he gets the feel of being there and make that a part of outside routine? x

thanks everyone, I think it does start as a threat but the nerves seem to take over but then rather than giving in and leaving (even though it's just in the car) it was how could he go to the toilet without going back to nappies.