Help getting ds to take responsibility for own toileting- consultant says he is lazy

[magso]

Ds is 9 and has mod/sevLD and ASD+ADHD. It has taken many years to get him mostly getting to the loo on time by day, but he still has the odd accident, often early or late in the day when the loo is handy ( so no excuse)! We now attend a paed for his continence needs, who feels we should make wetting and soiling completely unacceptable by shaming and punishing him. The letter to the GP from the paed says he wets because he puts it off ('otherwise known as laziness') and I feel quite upset - although I cannot quite say why!.
In the early years I was careful to be very unemotional and unfussy, although I have occasionally got quite upset. He has rarely soiled the bath since I accidentally cold showered him after the water unexpectedly ran cold washing the poo off! Dh also feels I am too soft and should just put him to bed once he has spoiled his clothes. Also he has truly appalling aim (at least half misses), which I insist he attempts to clean up but he still continues to miss unless I assist. Sometimes I feel he will never learn, and that I'll always be smelling of bleach!
It is not just toileting that is getting me down - ds needs continual reminders of rules like staying at the table. He can internalise but it will not stay without constant ( and I mean constant) reinforcment. Sometimes it feels like years go by and little progress is made.
Anyway what do you think? Ds is developing shame. Should I shame him more? It feels unnatural. Help. And what do you think to not changing his bed until wake up time?

I am sorry I have no experience of this so cant really advise, but I wanted to bump for you. I really dont know. I would think shame cant be a good productive thing... I guess you have tried all the usual incentives?

I think I am with your DH here, not in using shame or punishment, but in showing him that soiling is unacceptable by putting him straight to bed, or straight in the bath every time it happens. It has to become MORE of a pain for him to have an accident than it is to go to the loo at the right time. IME you have to trigger the feeling "I really should go to the loo because every time I don't something that is a pain happens to me". I would not call that punishment exactly, but maybe use the term aversive, and I think in the long run you are doing him a favour, as in the teenage years he may be mortified to be still having accidents. For my DS, I used choc rewards for good loo going, and bath straightaway (whatever time of day) for bad. Not a fun, toys in the bath, bath, but a swift and not fun one to wash him off. On the postive reinforcement side, I also put all his books and toys in the loo, as I was advised by a toileting expert to make the toilet a "destination of choice". I think your paed was wrong to use the word "lazy" as this fails to take into account his SEN, but I do think that if he can go to the loo properly 8 times out of 10, then he can definitely achieve 10 out of 10 quite soon and with just a bit of carrot and stick. Must admit my DS still wees sitting down, so I do not have the poor aim problem and cannot quite face tackling that yet. Good luck!

magso, the toilet independence is such a stressful thing isn't it?

I'm not sure about "shaming", maybe that will cause him a deeper issue in the long run. Put yourself in his shoes, just think of yourself as a little boy, how would you feel if your own mother made you feel ashamed of yourself? Surely that would have a negative effect in your self image.

I think sickofsocalledexperts has it just right. I would have some sort of tangible consequence for soiling and wetting (no favourite tv prog?), but I would also praise success. I made a little homemade smiley face chart for my DS and stuck it on the bathroom door, everytime he went to the toilet independently, I would stick a smiley face on the chart and praise him. He was really proud of himself and everytime DH came home he would bring him to show him the chart, I think it helped. POSITIVE REINFORCEMENT. Could you try something like that?

Thank You all of you.
I guess because he misses he doesn't get the full positive reinforcement anymore unless he manages to get the majority in the loo! (The missing irritates me as it is so hard to clean up!) Will have to make wetting his pants a much bigger consequence - than cleaning up after himself than missing. I have already limited him to one pair of trousers a day ( PJs after that). Then work harder on the missing!

Have you tried the Toilet training balls? I haven't used them, but apparently very useful!!!
google "Toilet training balls"
xx

Thanks Tinysocks. I tried table tennis balls early on to practice aim. The problem is that by the time he gets to the loo he is so desparate it is a bit late! I need to teach him how to recognise the symptons of an almost full bladder! He only seems to notice extremeurgency. If I notice signs like giggling he doesn't himself accept this means he needs to go!

pleas dont shame and punish your son.i cant believe a paed. would say such a thing. many children with ASD have toileting difficulties that can take a long time to sort. this little boy has ASD and ADHD-his life is already difficult.If he knows he is going to get into trouble each time he uses the loo cos his aim is poor, this will make him anxious and exacerbate the problem-at least at those times he IS using the loo.He will need constant reinforcement that is the nature of his conditions-he does not process info. as NT children.Use a sticker chart for those times he does use the loo and decide how many stickers he needs to get a reward-srart quite low, so that he can see there is an incentive for using the loo.Decide which aspect of the toileting you want to tackle first and work on that-dont try and do it all at once.(remember also, that childrn with ADHD and ASD are generally a couple of years behind their chronological age in terms of emotions and also socially). Take the pressure off of both of you- he uses the loo, you clean up afterwards-my son is 13, has ADHD,ASD, and still has terrible aim.This is usually worse if he is hurrying to get back to chosen activity.He was soaked every night till he was 9, then it just stopped. he wore pullups in bed, cos HVisitor could only provide nappies, and i didnt want to put him in nappies at that age. we used to change his pjs and pullups at night before we went to bed, but put a towel over wet sheet, unless it was absolutely soaked.Point out to paed. that your son is not lazy-if your son is engrossed in activity-ASD behaviour, to him toileting is an inconvience-he doesnt want to stop what hes doing-he doesnt think like NT children.Please dont be harsh with your son and do something that doesnt seem right to you, just cos so-called profess. says you should-he is offering advice and opinion-you dont need to accept it.Try and get your hubby on board with you. To me, it jhust seems if everyone is getting cross with him, it increases anxiety and can only make problem worse. By the way, i am no saint, and know it is exsasperating and hard not to get cross, but i have been in your shoes- my daughter had severe encropesis when younger, another son soiled and my youngest son soils also, though not on a daily basis. The paeds. we saw, were very clear, that we should not get cross and just change clothing etc with minimum of fuss- and we got there-just youngest son to fix-now wheres that bleach...