How to make the process of using new bathrooms fun, interesting, and successful!
I have spent 25 years working with a large variety of children many of whom have problems learning to use the bathroom at home, and then learning to use the bathroom at school or in the community. One of the fun things about being an occupational therapist is that I can be a sensory and emotional detective. If I can figure out what the child is thinking or feeling then I can often help solve the mystery of the bathroom problem. Many kids with autism don’t like new places, new smells, or new sounds. So it is our job as parents and educators to make the process of accommodating to new bathrooms fun, interesting, and successful.
Kids with autism may like to count, so one fun approach is to walk around the store or the school and count the number of bathrooms or the number of stalls inside of the bathroom. You can use the school’s floor plan or make a graph to keep ‘data’. For example on this field trip we found out that “Target has four stalls and five urinals”. If you can get the child engaged in counting the school bathrooms they will start to become familiar with the layout of the building. If you can get them interested in counting the stalls, you will help to get them familiar and desensitized to the particular bathroom that you would like them to use.
If the child is not all that enthusiastic about leaving a classroom to go count bathroom stalls I have made it even more fun by giving them a scooter board ride! After the child is comfortable entering the bathroom you can start to prepare the child to wash hands by going on another ‘field trip’. You can go with a question, e.g., does this bathroom have one or two sinks? What color is the soap? Do you dry your hands with a blow dryer or paper towels? After you have made a few visits to the bathroom it is usually clear what the obstacles are. Be sure to have your detective hat on and notice any signs of aversion to sounds or smells, as well as discomfort with the size of the toilets and sinks. The child’s particular aversion can be written into a social story and specifically practiced.
If you are a parent trying to get your child accustomed to going to restrooms in public places, don’t be shy about bringing his / her favorite toilet ring from home with you in a discrete bag so that your child can have the feel of home to start to become accustomed to using public restrooms. Depending on your child, you may want to consider taking several trips to visit the restroom at your favorite shops and restaurants before a real potty call is needed or expected. If you are going to be getting a second ring so that your child can have a favorite at school, be sure to let him / her use it a few times at home first, to get comfortable with it.
Even after they have become accustomed to the school’s bathroom I have found many of my students get stuck on some particular bathroom expectation. Some hate to flush the toilet but some want to flush it over and over! Just this year I had 2 students, in two different schools, who both insisted on taking off all their lower clothes when entering the school’s bathroom.
But do Social Stories really make a difference?
Research has established that the use of social stories is a highly effective intervention for children with autism and other special needs. In The use of Social Stories by teachers and their perceived efficacy. , informal teacher-made social stories were found to be “very effective” at 51%, “somewhat effective” at 47%, and “ineffective” at just 3%, as rated by the teachers themselves (Reynhout, G. & Carter, M. 2009).In addition to daily reading of their personalized story, ask the student questions about the story, and act out or role play situations (Chan, J., & O’Reilly, M. 2008). A doll can be used to role play bathroom specifics.
As I was addressing bathroom issues this school year I decided I wanted to have some ready made social stories to hand parents and teachers. The problem is, how do you write one social story when the problems are so varied? I came up with the format that you see here: half size pages, each with a unique text and a corresponding picture to cover a huge assortment of bathroom obstacles, including specific ideas for dealing with sensory aversions. There are several different covers, over 80 pages with visuals, plus two visual sequence strips for toileting, and 3 hand washing sequence strips. You choose the cover and pages that fit the needs and issues your student is dealing with now. Prioritize the problems. Pick only one or two issues that interfere the most, and after they are addressed, revise your book to help address the next issue. To make a complete beginning to end bathroom story, I have found best results when I include a few pages describing mastered or assisted steps as well.
I am loving this new product and so are the teachers and families that I work with. I hope you will too!
Special thanks to my OT colleague, Colleen McDonald for her insight and editing assistance. Also, heaps of thanks to the many clip artists who make a project like this possible! See preview