Potty training and eliminating diapers is a milestone every parent wants to check off their list but it’s a checkpoint that is often delayed for parents of children with sensory processing disorder (SPD). Additionally, the broad scope of SPD may complicate the potty training process in a number of ways and presents challenges that parents may not be attributing to disruptions in sensory processing. Like all things sensory, your child will experience the process in ways unique to him/her, but there are some elements that may be helpful to understand, as you embark on your “diaper-ridding” journey.
Introduction to Interoception: the 8th Sense
Angie Voss, Occupational Therapist at A Sensory Life and Author of “Understanding Your Child’s Sensory Signals” hi lights many of the challenges parents of sensory kiddos face. Voss points out,
“The ability for the body to make the connection with the brain that it is time to go to the bathroom, requires a properly working connection between the interoceptors in the bladder and bowels and the brain.”
This concept of interoception is a relatively new one in the field of sensory processing (which isn’t all that old itself). Interoception has to do with awareness of the internal state of the body through sensation. It is how organs communicate with the brain and the rest of the body. For example, being able to feel one’s racing pulse, feeling full after eating, detecting the difference between short shallow breaths vs. full inhales, or in this case noting the sensation of a full bowel or bladder. Occupational Therapist, Kelly Mahler has written a book “Interoception: The 8th Sensory System” and she suggests:
“Interoception enables us to experience essential feelings such as hunger, fullness, thirst, itch, pain, body temperature, nausea, need for the bathroom, tickle, physical exertion and sexual arousal. Additionally, interoception allows us to feel our emotions.”
Many children with sensory challenges struggle to self-regulate both physically and emotionally, and being able to regulate and respond to bowl and bladder cues is one of the physical tasks of self-regulation. Without effective interoception, accurate communication between the organs and the brain, learning to use the toilet will be more challenging. Additionally, if a child is older and has thus lived with dys-regulated pattens for a longer time, it may be more difficult to change. This doesn’t mean don’t try and it doesn’t mean it can’t happen, it means be realistic and account for the sensory challenges in whatever approach you choose to use when teaching your sensory kiddo to use the potty. Learn more about interoception by watching this video from the STAR Institute for SPD:
Hidden Sensory Spoilers to Effective Toileting
In addition to interoception, other senses play a key role in your child’s experience and readiness for potty training. Consider whether or not your child over or under-responds to auditory, tactile, visual, vestibular, and/or the “skunk” in the room (pun intended), smell. If your child has experienced differences in one or any of these systems in other areas of his/her life, it is possible these differences may have a significant impact on potty training as well. Here are some known examples:
Auditory – common auditory triggers for children who are hyper-sensitive to sounds include loud toilets, air dryers, slamming doors and echoing voices.
Tactile – common touch sensations that may trigger children who are hypersensitive to touch include the sensation of urinating or having a bowl movement, wiping afterwards, washing hands, sitting on a cold toilet seat, pulling pants up our down, or change in temperature to the skin with pants down during use of the toilet. Children who are under-responsive to touch may also be impacted by toiletting because they can’t feel the sensation until it’s too late or until just before going so struggle to transition from whatever they were doing. They may struggle to learn how to wipe effectively and/or may not feel secure sitting on a raised toilet because they don’t feel secure. They may struggle to sit still long enough to successfully use the toilet.
Visual – a common trigger for children who are hypersensitive to light is fluorescent lighting. Bathrooms also often have large or many mirrors which present not only reflections of the fluorescent light but a visual processing challenge for some children.
Vestibular – children with vestibular hyper-sensitivity, also known as gravitational insecurity become distressed when their feet leave the floor. Additional research is needed regarding the mechanism for this difficulty and to determine whether this experience is related to other vestibular symptoms. Children who are hypo-responsive to vestibular input may have low muscle tone and poor postural stability which makes sitting upright a challenge. They may also be the ones who struggle to feel sensations, and may have a hard time sitting still.
Smell – this sensory trigger seems obvious but smell triggers in bathrooms go beyond the smell of what goes into the toilet. Bathrooms often include air fresheners, scented lotions, soaps, and candles and towels dried with scented fabric softeners. The scent of cleaning solutions might make some children with smell sensitivity avoidant or down-right oppositional. Parents should also remember, that young children learn quickly what are considered to be socially acceptable explanations for avoiding certain things and blaming their avoidance on an offensive odor that everyone finds offensive is a one way to get out of doing something that they find difficult. It doesn’t mean children are being ill-willed in manipulating, it simply means parents may need to do some detective work to discover underlying triggers if children are blaming their avoidance of potty use on the smell of the “poop” alone. Children may not even know what other triggers are offensive because their avoidance is so automatic and so quick.
Sensory processing differences often demand that parents come up with different ways of approaching daily tasks with their children. In my private practice we work with parents to make daily tasks like potty training, easier. That doesn’t mean however that even with intervention, or sensory strategies that it will be easy. Parents need to recognize that every child with or without a diagnosis, has their own timeline and it is important to learn their child’s specific sensory pattern and profile so they may learn their child’s unique signals, patterns, and triggers. Understanding key elements of how sensory processing impacts potty training, can help to establish an effective plan for putting your child into “big boy or girl pants” for good.
If you’d like help in understanding your child’s sensory signals or if you’ve struggled with potty training and would like some support in your process, consider a parent coaching package which is not treatment. You may also call us to set-up an intake call at no charge, where we can help you decide what level of support best fits your child’s needs. The amount of support needed ranges from individual consultations to full assessment and intervention. Every family’s needs are unique. We are here to help.