Auntie, will you pop over to August 2012 Moms for me?

Cheerilee

Auntie (or any of you ladies!), would you mind weighing in on a post I started in August 2012 Moms?  SS8 with ASD has regressed with bathroom skills - DH spanked him over it and I am at a loss what's going on.  Spanking him is NOT the answer and DH feels bad for doing it but at the same time, peeing on the floor 8 times or so in 2 weeks is a bit much when he's been potty trained over a year.  I don't want DH to give up on him!  The post is called Heartbroken over DH and SS or something similar.   

I can't make it clicky, but this is the link: https://community.thebump.com/cs/ks/forums/thread/67425171.aspx

Thanks!

Cheerilee

This is the original post on 3rd tri... Someone pointed out an XP may be better.

________ DH and I have NEVER spanked SS.  I don't personally believe it is the best way to discipline.  That being said...Backstory:  My stepson is 8 and has autism.  He's come a long way but there are things that he still doesn't do consistently.  That's life.  I've been home with SS the whole month of July because he is out of summer school.  When SS's schedule changes, we see regression in speech.  However, lately he's regressed with using the bathroom, too.  In 2 weeks, he's peed on the floor 8 times.  He's in a pull-up all day because of all his accidents but he pees right through them.  By the time DH gets home, I'm frustrated and need a break - scrubbing carpets 8 months pregnant is not fun!  He has been telling me I'm overreacting.  He's been potty trained for over a year with MAYBE 4 accidents in a year - each time our fault because we didn't take him to the bathroom out in public.Last night:  Last night, SS hid behind the chair and peed his pants onto the floor.  I cleaned SS up and put him in his room for alone time while I cleaned up the carpet.  DH went into SS's room and comforted him - giving him a ton of attention.  I was incredibly angry with DH because he undid my consequence.  Today:  Earlier, SS went into the bathroom when I told him to go potty and peed all over the bathroom floor, toilet, and cabinet below the sink.  I was not sure if he purposely did this or just REALLY had to go and didn't make it to the toilet in time.  He had gotten his pants off and toilet seat up before he started peeing (he sits on the toilet).  I wasn't in the bathroom when he did this and didn't want to punish him for something if it was an accident.  I had him help me clean up the floor (the best an 8 year old can) then put him in the bath until I finished cleaning and mopping.  At dinner, he refused to eat.  We are working on new foods.  He wouldn't eat the chili (he'll eat it normally but we added hominy - the new food) so I gave him a peanut butter sandwich instead (he'll eat PB on raisin bread but not regular bread so we're working in the regular bread - the new food).  While sitting there, I hear the sound of pee hitting carpet... He's peed himself while sitting at the dinner table.  DH was ANGRY.  He took SS to the bathroom while I cleaned up the carpet.  While in there, he spanked SS.  That's SO out of character because we just don't spank.Now I feel awful for SS because I'm not sure he understands why daddy spanked him.  DH finally saw why I've been so frustrated about this and spanked him because it's the one thing I haven't done.  But really...  Ugh

If anyone has any suggested related to peeing on the floor so much... please.  The only big change has been we have had an in-home therapist to work on skills for independence (teeth brushing, hand washing, eating, drinking, staying within 2 feet in the parking lot, etc.).  A part of me sees escape behavior in this but I'm afraid I'm missing something.  

MummyGruetzie

I responded to your post on the Aug. 2012 board and then realized our due dates are days away from each other (I'm hardly ever on the pregnancy boards).... Look forward to seeing you around here more!

Cheerilee

Thanks, Auntie!  I'm going to respond in chunks so I don't lose track of myself! 

-auntie-:

Ugh. Shame on your husband.

I get that he was frustrated, but he seriously has to be the adult. Ideally, all discipline should be proactive, not reactive. For a child with autism this is critical. Think of discipline from its root "to teach" as Christ had disciples not punishers. Punishing a child on spectrum after the fact is foolish, only the most high functioning/marginally atypical approach the executive function skills to intuit a punishment totally unrelated to the crime. It's why ABA requires hours to break down and work on the individual components of the skills being taught.

 

Trust me...  DH feels awful and the worst punishment SS gets is time out in his room while we clean up messes.  Generally, we go through error correction procedures following a behavior (e.g. if he spills, he cleans it up).  He is VERY well behaved so this is very out of character for him IF it's a behavior issue rather than medical issue (he sees his pediatrician tomorrow to check for a UTI).  We both address behavior as teachable moments.  I am, however, the more consistent of the two of us since it's my background and DH is still learning new procedures put into place recently.  DH and I talked this morning about how situations like that need to be handled and if he feels THAT frustrated again, let me know and we'll switch roles - I'll take SS to get him cleaned up, he can clean up the carpet.

 

Did your SS get ESY? Could this regression be related to being out of the structure of school? Is he dry over night? Is he stressing about your new baby? Where is his mother in all this? Are you all on the same page? Do you have full time physical custody or is this summer visitation?

My SS's school doesn't offer ESY in the correct sense.  He went to summer school and, honestly, it's almost a waste.  They do "fun" stuff and therapies are not available like they are during the school year.  His ESY minutes are met in the general education classroom with a para and speech and OT go once a week to work with the special education students as a group.  I have definitely considered the changes he's had to endure in the month of July (we returned to our home state for a visit until mid-June, summer school, more baby stuff in the house, in-home therapy, I'm on a 2-week research project that's required me to be away from the house more in the past 2 weeks, DH was off this week, etc.).  Reflecting today, I think all of the changes have been too much for him to handle.  I take for granted, sometimes, that he IS so good at adjusting to new schedules and situations and forget that he may be overwhelmed by it all and need more preparation than he usually does.

He is dry overnight.  He always has been, even when not potty trained.  Though, he's still not 100% potty trained because he will ONLY urinate on the toilet.  We're still working on bowel movements.  

His mother is not in the picture.  DH has sole physical and legal custody and has had custody since he was 3.  He sees her twice a year for supervised visits.  When we were home last, she chose to only see him twice for one hour each time when she was allowed 3 hour visits each day.  She only recently regained custody of  her other two children after they were removed by the state 2 years ago to give you an idea of how she is...

 

It sounds like your SS has a significant degree of impairment given that you're working on adaptive skills at age 8 rather than social or self regulation skills. This probably means there is a cognitive or intellectual disability that complicates teaching.

My SS is not as cognitively impaired as it sounds.  We do not qualify money-wise for additional services beyond what we have.  It was through a temporary grant program that we were able to SS the therapy we did.  Our caseworker had to write goals that were related to safety and hygiene to get him qualified.  The 'powers that be' do not believe that social and self regulatory skills are addressable through habilitation therapy...  He is pretty independent minus stranger-danger, crossing the street, bathing, and brushing teeth.  The skills he's working on are really our fault - we did these things for him or just plopped him in a cart in a grocery store because it was easier and faster.  He was never taught to brush his teeth or wash his body/hair.  He dresses himself, picks up his room, puts away his clothes, puts dishes in the sink or dishwasher, among other things.  He plays soccer and basketball with friends, will ask (sign) students to play at recess, takes turns during indoor recess games, things like that.  Socially, he's come a long way and he is able to regulate his behavior.  He actually doesn't have any self-stimming behaviors that are too obvious.  He needs something in his hand during 'down time' but will relinquish it when asked. 

He's also completing the same required curriculum tasks as his peers within the mainstream classroom with modifications for responding.  He's reading on a late 2nd grade level (going into 3rd grade) and will arrange magnetic words to create sentences.  He does need a calculator for regrouping addition and subtraction and cannot form letters in handwriting.  His school is starting him on something similar to an Alphasmart next year and we're hoping to work with his SLP to turn his new iPad into a communication device.  They've tested his receptive language and it is within the average range.  His expressive is within the upper 60s.

 

Some thoughts-

I would talk with his doctor first. Urinary incontinence often has a physical cause. He could have a UTI or kidney problem. If he's on one of the neuroleptics, this could be a side effect.

We are checking out the possibility of a UTI tomorrow.  His urine is incredibly clear and unclouded so I don't suspect it, but just to be safe I set up an appointment this morning.  He isn't on any medications that this would be a side effect, though.  He isn't on any medications at all, actually.

 

Behavior is communication. When a child suddenly regresses in toileting it could be a cry for help. This is the classic behavior of a child who has been assaulted, btw. I have known families who report their child becoming incontinent when stressed at school by bullies. This is more common in kids with autism who have no or little speech. 

Behavior of this kind is sometimes a last resort communication. He could be protesting. Do you typically have physical custody or is this a summer visitation? Is this new therapy protocol very different than what he's used to in terms of intensity? I know that growth only comes from pushing a child outside of their comfort zone, but if you do too much or too quickly, you may have lost him. You could be absolutely correct about this being "an escape". DS had a classmate in 2nd grade who used to soil himself in the classroom to avoid gym and any other activities that didn't appeal to him. I've written about this kid before; he was 12 but was kept in 2nd grade because the middle school kids tried to light him on fire. The was something about this kid that incited bad behavior from others.

I am definitely looking this as a form of communication.  I address all behaviors in this way which often makes me overlook things such as schedule changes and medical issues.  His therapy is really lackadaisical - his therapist is...  well, not the greatest.  The consultant is on vacation right now and I need to talk to him about helping SS's therapist to establish more structure in their sessions rather than coming to me every 10 minutes asking me what he should do with SS next.  I have significantly more training than the therapist and it's more work for me to have him work with SS than it is for me to do it myself.  I just didn't want to have to be a full time therapist AND mom.  SS needs a mom, too.

I do not believe SS has been assaulted in any way.  He has a para with him at all times in school and DH or I am with him otherwise.  The only time he's been out of our care was this past weekend when we went to a wedding.  His para babysat for us.  If there were any other red flags, I'd question whether something not right happened while we were gone but there have not been.

How horrible for your DS's classmate! 

 

This is definately something I'd want to discuss with his psychologist once physical cause is ruled out. S/he should help you put a positive behavior plan in place to fade this behavior. An FBA might be useful to see if there's a pattern to his behavior.

SS actually doesn't have a psychologist here, yet.  He was just put onto my health insurance (his bio-mom was ordered to carry it in their court order and she dropped her insurance as soon as her other children were removed from her care and put on state insurance... we didn't know this until recently) so we've had to change all providers.  I am going to start watching closer to see what the actual antecedents and consequences are.  I've not been doing so immediately following the behavior because I've let my emotions take over and assumptions be made.  I'll share this with his consultant (and my friend through the university) to see what he suggests.     

 

Two other thoughts.

You may be feeding into this with the Pull Ups. Basically you're giving him permission to not use the bathroom by putting him in what is essentially a diaper. If you must use something, look into an adult diaper product which is designed full sized bladders. 

I hesitate to mention this but, be careful of language. There's a temptation to treat people with special needs- especially around intellectual and cognitive impairments- in ways that aren't age appropriate. If he's 8, he is getting really close to puberty (often kids with developmental delays enter puberty earlier than peers, btw) and should be "using the toilet/going to the bathroom" rather than using the "potty".

We have had him in underwear every day until very recently.  He does get a pull-up at night over his underwear in case he has a bowel movement.  He's been out of pull-ups for a year during waking hours.  Adult diapers do not fit him.  He's a whopping 45 pounds.  Pull-ups are the only thing we have found that fit him and we were REALLY hoping he wouldn't need them at all by now.  

DH uses "potty" to tell others when HE needs to go to the bathroom...  His parents/siblings/grandparents do, too.  I use bathroom and at school they say restroom.  SS is exposed to - and understands - all senses of the word.  We are careful to use age appropriate terms with SS (minus 'potty' because it's just a familial thing with DH).  We actually keep everything we can age appropriate around SS.  That's stubbornness on my part.  Too many of my students (I taught SPED for 5 years, behavioral consultant for 1 year, 2 years into a PhD in BD right now) liked or said child-like things or wore child-like clothing and were ridiculed for it.  I won't let that happen to SS.  He doesn't even own a pair of sweatpants.

Cheerilee

MummyGruetzie:

I responded to your post on the Aug. 2012 board and then realized our due dates are days away from each other (I'm hardly ever on the pregnancy boards).... Look forward to seeing you around here more!

I saw your response, and thank you!  I hope your pregnancy is going smoothly - we're almost there.  This is my first (and only) and I've been pleasantly surprised by how easily it's gone! 

Cheerilee

Thank you, thank you, thank you!

SS has had no accidents for 2 days now.  They've not be related to a UTI, though.  Interestingly, his therapist has not been here since Tuesday.  I am wondering what will happen when he starts back up next week (it turns out he never got his CPR/First Aid certification so he was NOT supposed to be coming).   

I have never had to bowel train a child so your approach is something I am definitely going to try.  I'm not sure that I trust sleep away camps in our area...  If we were back home, I know how the camps are run.  I'm not too impressed with services in our state.  It was something we had lined up before we moved - he'd made it to the top of the waiting list.  We just couldn't turn down the opportunity I had to finish out school with no money out of pocket.  I checked out day camps in our area for this summer after ESY had ended and they were just scary.  Great idea with scouting.  I hadn't considered that and that would be a great year-round activity.  

I agree with push-in services for OT/SLP being a good thing if done right.  His OT was good about pushing into classroom activities but the SLP is very 'old school' about services.  When she did push-in, she just took him to the back table away from his peers and did her normal thing.  It made him look even more different from his peers so SS's case manager had her return to her normal sessions.  His para began going to speech to learn what was being worked on so she could carry through in class.  As he progressed, his para backed off and is now just a classroom aid (rather than 1:1 aid) but available to SS when he needs her.

SS's BM is not diagnosed diagnosed with anything except being co-dependent - which she is.  She cannot be single.  However, I feel there is more there that is going undiagnosed (or she's just not telling DH if she is diagnosed with something).  I see some bipolar tendencies with her.  DH described manic episodes with her that suggest when she loses control, she cannot regain it.

SS had a Vineland done when he was 4.  It needs to be redone but when his re-eval came up, we signed off to say he didn't need to be tested by the school.  The staff has not had training in giving non-verbal assessments so was afraid of getting scores that did not really reflect where SS is currently.  I have a friend through my university who is a school psych for the school for the deaf and has had ample training in non-verbal assessments and experience in giving them to kids with hearing impairments and autism.  We will be having him privately evaluated.  I will ask for the Vineland.  I love the idea of using it for home-goals.  I wrote IEP goals for my students using it but just didn't bridge that idea over to SS.     

Thank you so much for your replies.  I feel like a failure often times because SS IS further behind than he should be.  I know DH and I can be better.  We just slack off at times so our consistency comes in waves - that's not OK.  Sometimes, I need to be called out on it.  Sometimes, I need ideas that help me work through things in a mixed role.  You've given me a perfect balance of both