Re: Quiz -- Is it behavioral or medical?

[Guest guest]

,

This is a tough one but I would try to treat it behaviorally. Is he

standing or sitting on the toilet? Did you move or did he switch schools (new

toilet that is different). I would go back to having him sit on the toilet

for

urine and BM...especially since he has had BM accidents too) and actually go

back to a schedule with lots of positive reinforcement for

urinating/defecating in the toilet. I would also use more prompting and make

sure someone is

with him in the bathroom for a few days/weeks as much as possible....then I

would slowly withdraw the prompting and decrease the positive reinforcement. I

would also hold off on the punishment .....at least for now ...consider

adding that back if things don't clear up going back to a schedule with

positive

reinforcement.....but it doesn't sound like over-correction is effective for

him at this point. I would take data and fade the schedule by 30 or 60

minutes if he has a day or two with no accidents.....I would also continue to

look

medically or biomedically.

We had a similar (although more mild) problem with Lucas last year. All of

a sudden, he was getting his pants wet when he urinated (sitting down, not

pulling his pants down enough and not pushing his penis down).....even after

years where this was not an issue......I went back to going in with him and

gesturally prompting to get his pants down and penis down....I also encouraged

him to stand for peeing. With several weeks of increased prompting, his pants

remained dry and we were able to fade out the person and prompts.

Toileting is covered in Chapter 11 of my book (The Verbal Behavior Approach:

How to Teach Children with Autism and Related Disorders). There is also a

FAQ re: potty training document on my web site (_www.vbapproach.com_

(http://www.vbapproach.com) ) that you can download in both English and

Spanish.

Best,

______________________

Lynch Barbera, RN, MSN, BCBA

_www.vbapproach.com_ (http://www.vbapproach.com/)

In a message dated 6/17/2008 3:09:09 P.M. Eastern Daylight Time,

persistentC@... writes:

Hi Gang,

I'm curious to hear your feedback about this...

My son, Kenny, is 15 years old. He has been potty trained since he was 3.

A couple of months ago, instead of urinating into the toilet, he began

urinating next to it. At first, I ignored the behavior, and just cleaned it

up, thinking it was just an accident. But as the incidents increased, I

began to suspect there was something more going on. My first thought was

that perhaps he had a UTI. I took a urine sample in to be tested (twice)

and the results came back clear.

After getting the test results, I decided to approach this behaviorally. I

started by just having him clean up his mess, but not making a big deal

about it. As this made no difference, I began making the cleaning up

process a little more aversive to him by increasing the amount I expected

him to do. This, too, made no difference. So then I began using over

correction. At this point he was clearly unhappy about the whole process.

However, it made no difference, and in fact, he began urinating on the

carpet of his room in the middle of the night. I began making him shampoo

the carpet, empty the water tank etc. Still, the behavior continued. After

a week or so of this, he began defecating on the carpet as well. Since the

stool was very loose and liquidy (a REAL mess to clean up) I thought I

should check to see if he was actually having a GI issue. (He has chronic

GI problems, including Crohn's Disease and Barrett's Esophagus.) I took

stool samples in to be tested, but these results, too, came back with no

problems detected. I also took him into the pediatrician'problems detect

exam twice. Two different doctors saw him, a couple of weeks apart, and

neither had any idea about what to do.

A week or so ago, I even caught him going into his room during the day,

pulling his pants down, and eliminating on the floor.

We started looking at foods that he was eating. In an attempt to expand his

diet, we had recently introduced some new items. I removed those foods, but

it made no difference.

So, for those who want to " bite " , what would your next step be? Do you

think it's behavioral or medical?

s

_persistentC@persisten_ (mailto:persistentC@...)

[Non-text portions of this message have been removed]

**************Gas prices getting you down? Search AOL Autos for

fuel-efficient used cars.

(http://autos.aol.com/used?ncid=aolaut00050000000007)

[Guest guest]

I can't help you much here but I have a similar problem and I too have no idea

if it is physiological or behavioral.? My son is 14 and again has been potty

trained since he was a pre-schooler.? For years, we had no trouble with his

using the tiolet or issues withhim ?wiping himself after a bowel movement.?

A couple of months ago, it seemed as if he began defecating in his underwear.?

He denied it and we looked to the issue of whether it was a problem with wiping

himself.? We worked on both reminders to use the tiolet when needed and

improving his self wiping skills.? One problem I did note is that since puberty,

his feces seems much " stickier " than in the past and thus harder to wipe clean.

I have focused more on positive reinforcement for " clean " underwear and he is

excited about the reinforcers.? Nevertheless, we still have a problem 2-3 times

a week.

Any thoughts would be welcome.

Pat Reagan

[ ] Quiz -- Is it behavioral or medical?

Hi Gang,

I'm curious to hear your feedback about this...

My son, Kenny, is 15 years old. He has been potty trained since he was 3.

A couple of months ago, instead of urinating into the toilet, he began

urinating next to it. At first, I ignored the behavior, and just cleaned it

up, thinking it was just an accident. But as the incidents increased, I

began to suspect there was something more going on. My first thought was

that perhaps he had a UTI. I took a urine sample in to be tested (twice)

and the results came back clear.

After getting the test results, I decided to approach this behaviorally. I

started by just having him clean up his mess, but not making a big deal

about it. As this made no difference, I began making the cleaning up

process a little more aversive to him by increasing the amount I expected

him to do. This, too, made no difference. So then I began using over

correction. At this point he was clearly unhappy about the whole process.

However, it made no difference, and in fact, he began urinating on the

carpet of his room in the middle of the night. I began making him shampoo

the carpet, empty the water tank etc. Still, the behavior continued. After

a week or so of this, he began defecating on the carpet as well. Since the

stool was very loose and liquidy (a REAL mess to clean up) I thought I

should check to see if he was actually having a GI issue. (He has chronic

GI problems, including Crohn's Disease and Barrett's Esophagus.) I took

stool samples in to be tested, but these results, too, came back with no

problems detected. I also took him into the pediatrician's office for an

exam twice. Two different doctors saw him, a couple of weeks apart, and

neither had any idea about what to do.

A week or so ago, I even caught him going into his room during the day,

pulling his pants down, and eliminating on the floor.

We started looking at foods that he was eating. In an attempt to expand his

diet, we had recently introduced some new items. I removed those foods, but

it made no difference.

So, for those who want to " bite " , what would your next step be? Do you

think it's behavioral or medical?

s

persistentC@...

[Guest guest]

Hi,

Denying he has a problem would suggest he is confused if not

overwhelmed by things in his environment, thereof? as a possibility?

Nothing is as clear as being strictly behavioral or medical to me.

What he is doing is communicating something, (if you can read it?)

and he is right in feeling what he does.. . Hello, to that?!.

Everything is communicating and I would suggest honestly

communicating (more so, all you can) with your child, thereof, for

what he wants and needs, of his feeling/s, thereof.. .

He should be in the drivers seat in that respect or he would not be,

in the end? .. .

Have him see other people, Individuals and experts, by all means, to

facilitate Communication, thereof? In all the ways you can? .. . I

suspect he would like that, if not respond to that appropriately.. .

This is only part of the solution, of that.. .

Mike,

I ABA

ABA for Understanding More

The not so hidden other message in this is not promoting " our "

language for the content I provide? (beyond that) of my feeling/s

thereof, but for Communication itself, thereof! Most of us are

selling a hidden (if not dirty/shitty?) message which (I Feel) is

usually the problem, of what " I " do and where I go, otherwise. I

fancy myself a good (meaningful) " narrator " in that respect, for the

results I get

The media is totally guilty of that, (subliminal messaging?) as are

most of the rest of us, I Feel as understand.. . Very much so,

towards what I am truly capable of, for my self, thereof.

That should open your mind, to what really matters of The facts, is

my sense of It.. .

Try things (More things, of Communication) for the results you get,

of ABA, thereof? .. . Of ABA, thereof, or " I " wouldn't have any part

of you.. . You understand.

A (my?) narrated product? It should prove to be the next way/wave,

and integrates " nicely " with errorless learning (along with

everything else, " meaningful, " that is.. .)+

I get what I need in that respect (I Feel as understand.

m.g.

Don't forget to see a medical doctor too, on the matter, in that

respect? .. . Be the leader, thereof.

>

> I can't help you much here but I have a similar problem and I too

have no idea if it is physiological or behavioral.? My son is 14 and

again has been potty trained since he was a pre-schooler.? For years,

we had no trouble with his using the tiolet or issues withhim ?wiping

himself after a bowel movement.?

>

> A couple of months ago, it seemed as if he began defecating in his

underwear.? He denied it and we looked to the issue of whether it was

a problem with wiping himself.? We worked on both reminders to use

the tiolet when needed and improving his self wiping skills.? One

problem I did note is that since puberty, his feces seems

much " stickier " than in the past and thus harder to wipe clean.

>

> I have focused more on positive reinforcement for " clean " underwear

and he is excited about the reinforcers.? Nevertheless, we still have

a problem 2-3 times a week.

>

> Any thoughts would be welcome.

>

> Pat Reagan

>

> [ ] Quiz -- Is it behavioral or medical?

>

>

>

>

>

>

> Hi Gang,

>

> I'm curious to hear your feedback about this...

>

> My son, Kenny, is 15 years old. He has been potty trained since he

was 3.

>

> A couple of months ago, instead of urinating into the toilet, he

began

> urinating next to it. At first, I ignored the behavior, and just

cleaned it

> up, thinking it was just an accident. But as the incidents

increased, I

> began to suspect there was something more going on. My first

thought was

> that perhaps he had a UTI. I took a urine sample in to be tested

(twice)

> and the results came back clear.

>

> After getting the test results, I decided to approach this

behaviorally. I

> started by just having him clean up his mess, but not making a big

deal

> about it. As this made no difference, I began making the cleaning up

> process a little more aversive to him by increasing the amount I

expected

> him to do. This, too, made no difference. So then I began using over

> correction. At this point he was clearly unhappy about the whole

process.

>

> However, it made no difference, and in fact, he began urinating on

the

> carpet of his room in the middle of the night. I began making him

shampoo

> the carpet, empty the water tank etc. Still, the behavior

continued. After

> a week or so of this, he began defecating on the carpet as well.

Since the

> stool was very loose and liquidy (a REAL mess to clean up) I

thought I

> should check to see if he was actually having a GI issue. (He has

chronic

> GI problems, including Crohn's Disease and Barrett's Esophagus.) I

took

> stool samples in to be tested, but these results, too, came back

with no

> problems detected. I also took him into the pediatrician's office

for an

> exam twice. Two different doctors saw him, a couple of weeks apart,

and

> neither had any idea about what to do.

>

> A week or so ago, I even caught him going into his room during the

day,

> pulling his pants down, and eliminating on the floor.

>

> We started looking at foods that he was eating. In an attempt to

expand his

> diet, we had recently introduced some new items. I removed those

foods, but

> it made no difference.

>

> So, for those who want to " bite " , what would your next step be? Do

you

> think it's behavioral or medical?

>

>

> s

> persistentC@...

>

>

>

[Guest guest]

Some thoughts on this.

1) Is he enjoying the clean-up task? If so it may be reinforcing the

negative behaviour. Just because we find cleaning feces and urine

objectionable doesn't mean he will.

It could be he enjoys the heavy work of scrubbing and the vibrations

from the rug shampoo machine. If so he has learned that he can only

get this input by messing the floor.

2) Is he confusing masturbation and elimination. It could be he has

had a pleasant experience with the one and is trying to recreate it

with the other. TMI maybe but a valid question I think.

He is still choosing to eliminate (i.e.) pulling down the pants etc)

so it is his choice of where that you are dealing with.

Puberty is a rough time for our typical children. I can only imagine

what our ASD kids are dealing with from a sensory and hormonal

perspective. According to my DD the " typical " 13/14 YO boys in her

class are obsessed with bodily fluids.

Go back to floating bits of paper in the toilet and get him to hit the

target standing up. Then reward heavily.

Also give him lots of sensory water play during non toileting time.

Washing the car or outside toys. Watering flowers. If the testosterone

is raging give hime big muscle work like scrubing the patio stones or

kitchen floor with a scrub brush and water mixed with kitchen soap if

he finds this rewarding.

Good Luck.

>

> Hi Gang,

>

> I'm curious to hear your feedback about this...

>

> My son, Kenny, is 15 years old. He has been potty trained since he

was 3.

>

> A couple of months ago, instead of urinating into the toilet, he began

> urinating next to it. At first, I ignored the behavior, and just

cleaned it

> up, thinking it was just an accident. But as the incidents increased, I

> began to suspect there was something more going on. My first

thought was

> that perhaps he had a UTI. I took a urine sample in to be tested

(twice)

> and the results came back clear.

>

> After getting the test results, I decided to approach this

behaviorally. I

> started by just having him clean up his mess, but not making a big deal

> about it. As this made no difference, I began making the cleaning up

> process a little more aversive to him by increasing the amount I

expected

> him to do. This, too, made no difference. So then I began using over

> correction. At this point he was clearly unhappy about the whole

process.

>

> However, it made no difference, and in fact, he began urinating on the

> carpet of his room in the middle of the night. I began making him

shampoo

> the carpet, empty the water tank etc. Still, the behavior

continued. After

> a week or so of this, he began defecating on the carpet as well.

Since the

> stool was very loose and liquidy (a REAL mess to clean up) I thought I

> should check to see if he was actually having a GI issue. (He has

chronic

> GI problems, including Crohn's Disease and Barrett's Esophagus.) I took

> stool samples in to be tested, but these results, too, came back with no

> problems detected. I also took him into the pediatrician's office

for an

> exam twice. Two different doctors saw him, a couple of weeks apart, and

> neither had any idea about what to do.

>

> A week or so ago, I even caught him going into his room during the day,

> pulling his pants down, and eliminating on the floor.

>

> We started looking at foods that he was eating. In an attempt to

expand his

> diet, we had recently introduced some new items. I removed those

foods, but

> it made no difference.

>

> So, for those who want to " bite " , what would your next step be? Do you

> think it's behavioral or medical?

>

>

> s

> persistentC@...

>

>

>

>

[Guest guest]

Puberty does present challenges in that respect. Good point. Things

seem to have gotten chaotic if not outright regressive in our

situation with our son at about that time. There may be things you

could do with respect to that, hormonial issues, medically? .. .

The problem passed relatively quickly in our situation. Maybe within

6 months, doing all that we could do with ABA, and keeping the

demands (and expectations) down somewhat, and being " reassuring " .. .

(It wasn't a big problem. Peeing in his bed during sleep mostly, a

few times. " Everyone " is different of course.) More options seem to

be available these days, not without their problems.. .

Mike

Love is in Communication

Punctuate it as you wish.

> >

> > Hi Gang,

> >

> > I'm curious to hear your feedback about this...

> >

> > My son, Kenny, is 15 years old. He has been potty trained since

he

> was 3.

> >

> > A couple of months ago, instead of urinating into the toilet, he

began

> > urinating next to it. At first, I ignored the behavior, and just

> cleaned it

> > up, thinking it was just an accident. But as the incidents

increased, I

> > began to suspect there was something more going on. My first

> thought was

> > that perhaps he had a UTI. I took a urine sample in to be tested

> (twice)

> > and the results came back clear.

> >

> > After getting the test results, I decided to approach this

> behaviorally. I

> > started by just having him clean up his mess, but not making a

big deal

> > about it. As this made no difference, I began making the

cleaning up

> > process a little more aversive to him by increasing the amount I

> expected

> > him to do. This, too, made no difference. So then I began using

over

> > correction. At this point he was clearly unhappy about the whole

> process.

> >

> > However, it made no difference, and in fact, he began urinating

on the

> > carpet of his room in the middle of the night. I began making him

> shampoo

> > the carpet, empty the water tank etc. Still, the behavior

> continued. After

> > a week or so of this, he began defecating on the carpet as well.

> Since the

> > stool was very loose and liquidy (a REAL mess to clean up) I

thought I

> > should check to see if he was actually having a GI issue. (He

has

> chronic

> > GI problems, including Crohn's Disease and Barrett's Esophagus.)

I took

> > stool samples in to be tested, but these results, too, came back

with no

> > problems detected. I also took him into the pediatrician's office

> for an

> > exam twice. Two different doctors saw him, a couple of weeks

apart, and

> > neither had any idea about what to do.

> >

> > A week or so ago, I even caught him going into his room during

the day,

> > pulling his pants down, and eliminating on the floor.

> >

> > We started looking at foods that he was eating. In an attempt to

> expand his

> > diet, we had recently introduced some new items. I removed those

> foods, but

> > it made no difference.

> >

> > So, for those who want to " bite " , what would your next step be?

Do you

> > think it's behavioral or medical?

> >

> >

> > s

> > persistentC@

> >

> >

> >

> >

[Guest guest]

Hi ,

Have seizures been ruled out? Since some kids with ASD develop

seizures in adolescence, this may be what is causing the accidents.

See http://www.emedicine.com/neuro/TOPIC658.HTM

for a description of the relationship between seizures and the effects

on the autonomic nervous system (which controls bowel/bladder

function). Some kids have absence seizures for years before they are

eventually diagnosed.

Good luck, I hope you figure it out soon.

April Choulat

>

> Hi Gang,

>

> I'm curious to hear your feedback about this...

>

> My son, Kenny, is 15 years old. He has been potty trained since he

was 3.

>

> A couple of months ago, instead of urinating into the toilet, he began

> urinating next to it. At first, I ignored the behavior, and just

cleaned it

> up, thinking it was just an accident. But as the incidents increased, I

> began to suspect there was something more going on. My first

thought was

> that perhaps he had a UTI. I took a urine sample in to be tested

(twice)

> and the results came back clear.

>

> After getting the test results, I decided to approach this

behaviorally. I

> started by just having him clean up his mess, but not making a big deal

> about it. As this made no difference, I began making the cleaning up

> process a little more aversive to him by increasing the amount I

expected

> him to do. This, too, made no difference. So then I began using over

> correction. At this point he was clearly unhappy about the whole

process.

>

> However, it made no difference, and in fact, he began urinating on the

> carpet of his room in the middle of the night. I began making him

shampoo

> the carpet, empty the water tank etc. Still, the behavior

continued. After

> a week or so of this, he began defecating on the carpet as well.

Since the

> stool was very loose and liquidy (a REAL mess to clean up) I thought I

> should check to see if he was actually having a GI issue. (He has

chronic

> GI problems, including Crohn's Disease and Barrett's Esophagus.) I took

> stool samples in to be tested, but these results, too, came back with no

> problems detected. I also took him into the pediatrician's office

for an

> exam twice. Two different doctors saw him, a couple of weeks apart, and

> neither had any idea about what to do.

>

> A week or so ago, I even caught him going into his room during the day,

> pulling his pants down, and eliminating on the floor.

>

> We started looking at foods that he was eating. In an attempt to

expand his

> diet, we had recently introduced some new items. I removed those

foods, but

> it made no difference.

>

> So, for those who want to " bite " , what would your next step be? Do you

> think it's behavioral or medical?

>

>

> s

> persistentC@...

>

>

>

>

[Guest guest]

Pat,

It may be that your son is experiencing encopresis, which is

involuntary. I learned about this condition from a parent of a teenage

boy (not on the spectrum). Wikipedia has an overview of it:

http://en.wikipedia.org/wiki/Encopresis

If this is the case, that is probably why he is still having a problem

2-3 times a week despite positive reinforcement.

Hope this helps,

April

>

> I can't help you much here but I have a similar problem and I too

have no idea if it is physiological or behavioral.? My son is 14 and

again has been potty trained since he was a pre-schooler.? For years,

we had no trouble with his using the tiolet or issues withhim ?wiping

himself after a bowel movement.?

>

> A couple of months ago, it seemed as if he began defecating in his

underwear.? He denied it and we looked to the issue of whether it was

a problem with wiping himself.? We worked on both reminders to use the

tiolet when needed and improving his self wiping skills.? One problem

I did note is that since puberty, his feces seems much " stickier " than

in the past and thus harder to wipe clean.

>

> I have focused more on positive reinforcement for " clean " underwear

and he is excited about the reinforcers.? Nevertheless, we still have

a problem 2-3 times a week.

>

> Any thoughts would be welcome.

>

> Pat Reagan

>

> [ ] Quiz -- Is it behavioral or medical?

>

>

>

>

>

>

> Hi Gang,

>

> I'm curious to hear your feedback about this...

>

> My son, Kenny, is 15 years old. He has been potty trained since he

was 3.

>

> A couple of months ago, instead of urinating into the toilet, he began

> urinating next to it. At first, I ignored the behavior, and just

cleaned it

> up, thinking it was just an accident. But as the incidents increased, I

> began to suspect there was something more going on. My first thought was

> that perhaps he had a UTI. I took a urine sample in to be tested (twice)

> and the results came back clear.

>

> After getting the test results, I decided to approach this

behaviorally. I

> started by just having him clean up his mess, but not making a big deal

> about it. As this made no difference, I began making the cleaning up

> process a little more aversive to him by increasing the amount I

expected

> him to do. This, too, made no difference. So then I began using over

> correction. At this point he was clearly unhappy about the whole

process.

>

> However, it made no difference, and in fact, he began urinating on the

> carpet of his room in the middle of the night. I began making him

shampoo

> the carpet, empty the water tank etc. Still, the behavior continued.

After

> a week or so of this, he began defecating on the carpet as well.

Since the

> stool was very loose and liquidy (a REAL mess to clean up) I thought I

> should check to see if he was actually having a GI issue. (He has

chronic

> GI problems, including Crohn's Disease and Barrett's Esophagus.) I took

> stool samples in to be tested, but these results, too, came back with no

> problems detected. I also took him into the pediatrician's office for an

> exam twice. Two different doctors saw him, a couple of weeks apart, and

> neither had any idea about what to do.

>

> A week or so ago, I even caught him going into his room during the day,

> pulling his pants down, and eliminating on the floor.

>

> We started looking at foods that he was eating. In an attempt to

expand his

> diet, we had recently introduced some new items. I removed those

foods, but

> it made no difference.

>

> So, for those who want to " bite " , what would your next step be? Do you

> think it's behavioral or medical?

>

>

> s

> persistentC@...

>

>

>