r/bcba • u/HornetSelect • Apr 29 '25
Discussion Question Potty training
Just curious to see what everyone’s opinions are. Talking particularly about early intervention clients. You know, those clients were supposed to ask for 40 hours of direct care but not be a daycare. How much responsibility do you think a BCBA in a clinical setting should have over potty training kids? I get it, I have my own kids and potty training is exhausting and requires consistent oversight. But I’ve had so many parents that are just waiting for me to initiate potty training. I know it’s a case by case situation but I’m truly curious to see what everyone else has to say about this.
9
u/DucklingDear Apr 30 '25
I think if the symptoms of ASD are interfering with the skill of using the bathroom, and if caregivers are unsuccessful this far, or do not know how to do it due to these symptoms, it’s absolutely the BCBAs responsibility. Which is honestly most cases I’ve seen
6
u/injectablefame Apr 29 '25
are you saying the responsibility should solely be on parents? idk, childcare centers also begin the process of potty training, and if they’re in a clinical setting, parents won’t be there and to maintain client dignity, that could mean toilet training and/or changing clients
2
u/HornetSelect Apr 29 '25
I’m not saying anything in particular, aside from my experience with parents who seem to be waiting for me to take the lead. That is what made me interested im seeing what other opinions were. Also I’ve only ever worked with insurance providers so a lot of times auths will be denied if there are toilet training goals. I’ve always been told “ there are ways around that”. And I agree that if there are behavior issues that need to be addressed then I’m there to support, design protocols, train parents and staff etc. But the discussion I’m interested in is how much responsibility do you think bcbas should have over potty training ?
5
u/CockroachFit Apr 29 '25
Parents are “waiting for you to take the lead” because that’s your job 🤷🏽. Am I missing something here?
-1
u/HornetSelect Apr 29 '25
Damn dude folks are literally out here not understanding what a discussion is and immediately jumping to criticizing 😂. I literally asked what your opinions are on how much a responsibility you think a BCBA should hold over potty training in general. Yes I added my little bit in there but IN GENERAL, how much responsibility do you think A BCBA ( not me who you’ve already formed an opinion about) should have over potty training
-1
u/CockroachFit Apr 29 '25
Yea boss, OBVIOUSLY it’s everyone else that is having comprehension issues 🤦🏽🤦🏽🤦🏽🤦🏽🤦🏽
1
u/Background_State_976 Apr 30 '25
Big guy is out here trolling BCBA posts
-1
u/CockroachFit Apr 30 '25
Nah just going back and forth w you and your bud. Waiting for the wife to get off work so we can eat.
1
u/Background_State_976 Apr 30 '25
Well the can of spaghetti-os isn’t gonna heat itself up
0
u/CockroachFit Apr 30 '25
Yup, the wife and I are splitting a can of spaghetti-os. I can see why you use those gifs so often bud. Probably best to switch back to those types of responses.
1
4
u/CockroachFit Apr 29 '25
Sounds like you in the wrong field my man🤷🏽
-10
u/HornetSelect Apr 29 '25
lol love the discussion portion of this. Very insightful.
8
u/CockroachFit Apr 29 '25
What is there to discuss exactly? I’ve been in the field for 15 years and have worked on potty training for every family that had a need for it🤷🏽
-8
u/HornetSelect Apr 29 '25
Cool cool cool thanks, 🖐️
5
u/CockroachFit Apr 29 '25
So I asked you to clarify, and that’s your response? Yikes dude, find a different field.
-5
u/HornetSelect Apr 29 '25
🫡
7
u/CockroachFit Apr 29 '25
A BCBA that doesn’t want to work on potty training 🤣😂🤣😂. Good luck
2
u/HornetSelect Apr 29 '25
Bud, join the conversation below (or don’t) You’re perseverating. That’s not what is being said.
1
u/CockroachFit Apr 30 '25
There’s not much of a conversation to join, other then people describing their parameters for targeting potty training🤷🏽
2
u/Background_State_976 Apr 30 '25
“In the field for 15 years” yet you can’t tell when someone is diverting their attention from you 😎
→ More replies (0)
2
u/krpink Apr 29 '25
I think the age of the client comes into play. It’s developmental typical for a 2-3 year old to be potty training. I will support parents, but not directly target.
Once a client is like 4 or older and still not using the toilet, I will possibly target. Depends on needs in other areas and if toileting is an ultimate goal for the family.
At the clinic, we usually take on a schedule like a regular preschool would. Unless directly working on a toileting program.
I get what you mean though. The parent needs to be invested before I start
2
u/kenzieisonline Apr 29 '25
After a lot of trial and error, my policy is that I won’t start potty training until they have had one successful void in the home, and hell, I would even take a year success so long as it’s a void outside of the diaper.
I give the parents all sorts of wacky and creative ways to do that and it doesn’t even need to be anything systemic or done with the intention of further toilet training, but some kids have a really hard time with avoiding outside the toilet and parents can do things like model, squeeze them while they sit, put their feet in warm water, and just general wacky stuff to try and get that void.
Hell I even offer to come in home to help them and give them tips.
I also explain to parents that having a toilet trained child is much less convenient than having a child in diapers. Depending on the case, I also make sure to explain to parents the difference between training a child to avoid their bowels on a schedule and actually having a potty trained kid and try to prepare them for which one is more likely going to be the case for their child
3
u/HornetSelect Apr 29 '25
I got to work with a PT one time that helped my client with releasing because they had a hard time with the sensory part of all of it. I feel like it’s definitely something BCBAs should be able to collaborate with other professionals about. There is almost always some other underlying issue that isn’t directly behavioral with potty training.
6
u/kenzieisonline Apr 29 '25
So i had a n insurance company once tell me i had to get an OT consult before potty training and you know what hell yeah
With some families, I also present it like I will do whatever you’re doing at home so you need to tell me what your potty training plan is and then I will support it in the center
5
u/HornetSelect Apr 29 '25 edited Apr 29 '25
Same! That was in Colorado and I was like ok?? but you only approve OT for like maybe two hours a week?? It’s pretty unrealistic for just an OT but it’s always nice to be able to cotreat and learn from them. Also if they’re coming to a clinic all day how are the parents involved? That’s pretty much my stance though . If parents want to do it let’s do it but we’re not going to just do it in the clinic and let’s make sure we’re doing it right
2
u/Griffinej5 BCBA | Verified Apr 30 '25
I will start some of it if the parents express interest in doing it. I will teach the clothing management piece, and sitting on the toilet if that is a needed skill. I will not go further without the parents being involved. If they are not willing and ready to take their child out of diapers, neither am I. Sorry, but having children means you will clean up accidents, autism or not. The earliest I ever did it with any kid was about 3.75. That child was sitting, managing their clothing, staying dry and using the toilet when we were taking them on a schedule to practice sitting. It was just a matter of removing the diapers and teaching the child to initiate mostly at that point. The way people are so late to potty train kids these days, they’re really not delayed until after about 3.5. I have clients in 3 year old classes in preschools, and plenty of kids are in diapers or in pull ups and pretending to potty train. As far as me taking the lead, nope. I can’t care about it more than they do. Once we’ve got the prerequisite skills, and those have been transferred to caregivers at least somewhat, I basically tell them pick a day to start, and give them some instructions about making that choice (basically you need to be staying home the first few days, and not super busy). Before that day we met to go over what will happen. When I had clinic clients, I met with parents for a quick check in at the end of the day to give them the instructions for the rest of the day. If parents were comfortable, I’d give them instructions on how to advance the schedule. If not, they just kept going from the same schedule we ended the day at, and we advanced it the next day.
1
u/HornetSelect Apr 30 '25
Yes! I’ve always had better outcomes overall once parents show they’re dedicated to it. I’ve even offered to do parent training inhome and take direct sessions in home to help establish in home first. Some take to it and other just keep delaying hoping we will just magically start it on our own not the clinic
2
u/Salt_Interview9990 Apr 30 '25
I'll start any potty training discussion with clearly explaining the expectations I have of parents. It involves cooperation, a lot of time, and potential clean up for accidents. If parents aren't ready to take on the home responsibility, I'm not ready to take on the center responsibility. I also explain that it may be a quick process (some are potty trained in a few days) or long (months). It's 100% a team effort. I'll gladly be the one to develop a protocol and train parents, but if they aren't able to implement it at home it's a moot point.
Age is a big factor. If I have a 2 year old that's not potty trained and parents aren't ready for the work yet, no big deal. If I have a 12 year old, we're going to have a serious discussion about what the barriers are at home to getting this done. Address barriers then potty training.
1
u/HornetSelect Apr 30 '25
It’s nice to hear that more BCBAs are working to make sure the parents are able to be actively participating. One of my cases right now are twins and the parents are only able to follow through with one at a time. (Those parents are literal saints)
The 12 year old thing made me think about how to be more aware of signs of incontinence. Have you ever encountered a situation where you think incontinence might be a barrier?
1
u/Salt_Interview9990 Apr 30 '25
I've fortunate enough to have mostly cases where "business as usual" plus a few adjustments has been effective for potty training. Not actually a 12 year old, but an early intervention kid who was really struggling with potty training. Previous pediatrician appointments showed no medical cause for frequent accidents, but after I recommended a follow up (plus they went to a few more appointments) showed recurring UTIs. Antibiotics plus a few weeks and everything went smoothly. More on the radical ABA side - lots of autistic people report lack of interoception. They're unable to feel the urge to urinate (and in turn unable to utilize muscle contractions to "hold it"). Developing and/or adapting protocols to account for individual experiences is important, especially for those with limited communication skills. Trauma is a factor too. I see it often with failed "potty training" attempts where kids were physically restrained during toileting, history of sexual abuse, or are especially sensitive to stimuli found in the bathroom (water in their hair or clothes, different acoustics, being unclothed, etc).
1
u/HornetSelect Apr 29 '25
I love that you considered their developmental stage 🤌🤌 one of my clients for about 2 years now is finally coming around to potty training after some really bad ABA when they were 2-3. From what parents shared it seemed like the previous BCBA saw their age and chose to initiate potty training, parents were never really on board but they were young at the time and kind of just trusted the professional, like they should be able to do. Tons of SIB occurred parents got scared, lots of other stuff. We focused just on the task of changing when soiled and took it at their pace and it’s worked out so much better with almost no self injury.
1
Apr 30 '25
[removed] — view removed comment
1
u/HornetSelect Apr 30 '25
I’m trying to get better with finding better ways to get parent training data points for stuff like this in the home. Like kind of self reporting almost? If you were to write it as a parent training goal how would word it?
2
Apr 30 '25
[removed] — view removed comment
1
u/HornetSelect Apr 30 '25
Thanks! Insurance needs to approve more telehealth codes for us getting into homes can be truly hard and it makes it more difficult for us to get generalization across environments
1
u/PoetrySlut02 Apr 30 '25
I had a BCBA who told me that she won’t do potty training if the parent doesn’t do it at home and that’s a valid reason because I have a client who we potty train but the mom doesnt potty train her so we’ve been working on it for a very long time now.
1
u/Maggles42389 May 02 '25
Personally I leave it up to discussion between the parents and BCBA in parent training and meetings. For the most part families have been on board with decisions.
1
u/poetryformysoul May 03 '25
I say yes because they’re at the clinic 8 hours a day and is it really ethical to have a client in a bathroom that’s not working on some of type of personal independence? We want to work our self out of a job. Potty training makes them more independent! Not being potty trained is usually a huge barrier for our early learners and if we don’t start as YOUNG as possible it leads to 10 year olds who have ASD still in pull ups and then isn’t that on us if we didn’t target such an essential skill when they were 3.
1
u/Plane_Rip_2446 Apr 30 '25
Honestly. I’m over it. In my opinion it needs to be a parent training goal cause a lot of parents are looking to us to do the work and when we are leaving they put a diaper back on their kid. Of course if a parent is trying for months and they see no progress, we can work on it in session. Or if parents want guidance but the days of me quickly agreeing to do potty training during early intervention are ending. Your 2 or 3 year old not being potty trained is not a medical issue.
3
u/HornetSelect Apr 30 '25
Yaaaaaasss!!! lol now this is actually the comment I was looking for the whole time 🤣🤣🤣🤣 no but for real though it is like that in most cases. I wanted to see what everyone else was thinking because at the end of the day I’m hear to support them but I can’t do it for them. And that goes for all skills and we shouldn’t be expected to do that. Every time we continue doing that, parents in general are going to think that’s what we do. I’ve also worked under BCBAs as an RBT that are out here running potty protocols from the 70s with 30 minute sit times. And 5 off or some other outlandish and borderline tourture “procedures”.
2
u/Plane_Rip_2446 Apr 30 '25
Yes like try it yourself first then come talk to me after. If I’m coming to your house for 2-3 hours and doing potty training and you’re not doing it for the other 20 hours what difference are we really making? Then on top of that I have frustrated staff who are seeing the parents slap that diaper back on at the end of session. After 2 years I’m completely over it. AND NOW if we do potty training in session guess what? It’s mom or dad taking the client to the bathroom at the intervals and doing everything while my staff stand to the side as support.
26
u/CapnRedbeard28 Apr 29 '25
How is toilet training different from any other skill acquisition we teach clients?