The other pretty amazing thing that came out of ABA (there were lots but this one was evidentially visible!) was the “stopping of the smearing”. It was summer of 2018 and I remember one day smelling poo downstairs. Great, another dirty nappy! What I didn’t expect when I came down was the poo was all over Ryan’s hands and face and oh my gosh – on his teeth! You know when you get one of those horror moments when time stands still and you just don’t know what to do – well this was one of them for me! After what seemed an eternity (but was probably only 5 seconds!) I grabbed Ryan and put him in the shower. I washed (scrubbed) him and his hands and body, his fingernails, his hair (which I could see was soiled also) and then his face and teeth. He didn’t like brushing his teeth those days and usually I would need to hold him down to get a brush in his mouth. Well not today!! Somehow, I managed to get the brush and a ton of toothpaste in that boy’s mouth and brushed it! Now that he was clean, I left him upstairs and closed the gate whilst I went to investigate downstairs. With a plastic bin bag in one hand and a tub of industrial antibacterial wipes in the other I went on a mission to search for the poo. The walls in the landing had smears as did the door to the living room and the door handles. I cleaned as I went – doors, windows, light switches, floors, walls – anything that was in sight. The back door to the garden was open at the time so I went outside to check – at first glance I couldn’t see anything but then I noticed a few flies swirling around the washing line where my clothes were drying. Please no… I prayed as I walked over. But yep, he’d got the washing line too (hence the flies) and so as I cleaned the line I took down all the clean (and almost dried) clothes to be re-washed again.
That smearing experience was the first of many. I began to think these happened only when I was around as no one else seemed to experience it until one day when I was at work and my husband was with the twins he called me said “Ryan did it today with me”. He was vocally distressed (although to be fair any form of poo for him was stressful 😂) but this day I realised it was a bigger problem. We were all on guard, trying to watch Ryan so that whenever he was pooing we were around to watch, make sure his hands didn’t travel to his nappy.
It was only the following week that I mentioned it to our BCBA. Why didn’t I mention it sooner? I guess I was embarrassed – surely a child smearing means his parents aren’t doing a great job of watching and keeping an eye on him? J looked at me and said “right, that’s not a problem, we just need to toilet train him”. And that was it!
We spent the next two months toilet training Ryan who I thought wasn’t ready and it hadn’t come across as part of my plan to train him. J was great – it was the summer holidays and she had some capacity and so pretty much daily (4x a week minimum) she came home for 3hrs/time and worked directly with Ryan as a tutor herself. The aim: toilet train Ryan.
After two months of intensive training using ABA principles, Ryan was no longer wearing nappies during the day. He wore them at night though (and just so you know he still does today, age 8) but he now wore pants only in the day. He still needed to be prompted to go to the toilet so the setting and us at home would take home every 1-1.5hrs just to make sure there wasn’t an accident. He did of course have accidents (and still does today) but we managed to get him out of nappies during the day but most importantly stop him from playing with his poo in his nappy! Whenever we could see he was about to touch his poo (either on him or in the toilet) we would bring back the ABA specifics and stop him.
Call it how you want but as I said earlier this was life changing for us – and him.
If need be, hold his hands gently to block him from putting them down his trousers or up to his mouth after an accident.
Toilet Training Protocol
The training consisted of the following key principles:
- Taking Ryan to sit on the toilet every 15 minutes
- Trying to get him to drink as much liquid as possible
- Giving him huge amounts of praise and reinforcement for urinating on the toilet
- Not giving any reaction/eye contact/talking when he urinates elsewhere, but taking him to sit on the toilet and then getting him to wipe the area he peed with a baby wipe (we understand that an adult will have already cleaned the floor for health and safety!). Ryan loved this bit (and still does!) Sometimes when he’s spilled a drink he’ll grab tissues (usually the entire roll!) and start wiping it up, I think he enjoys watching the tissue soak up all the liquid 🙂
Ryan must be watched closely at all times when in pants. He consistently touches, smears and eats both urine and poo when he has accidents in pants. This must not be allowed to happen. As soon as he has an accident, he must be wiped, cleaned and put in clean pants.
This protocol focuses on using key elements from the evidence-based study on toilet training with developmentally disabled persons by two behavioural psychologists named Azrin and Foxx – and you can find clear details of the protocol here: – 96. Handout 1_0.pdf (psu.edu)
Once you’ve nailed the above you can then look to teach the child (if a boy) how to stand up and pee. However, we never got to this bit because even to this day Ryan still pees sitting down and quite frankly, I have no intention of changing that just yet. He pees well and IN the toilet (standing up would have spillages for sure!! 😂) so for right now it’s all good!
The above is a protocol was used for Ryan however you should always check with your ABA practitioner before you try it out as it might not be suitable for your kiddo. For me, I wanted to simply stop the smearing and would use any (safe) method to do so. I’d also quickly like to remind everyone how unsafe it is for a child/person to eat/put in their mouth their own faeces. It can spread diseases and parasites, and ingesting faeces can lead to illness and infections. And I add this reminder here before negative comments are made about ABA and/or the method used to toilet train and stop smearing.
If you want further info as to “why” our children might smear, then there’s plenty of info online but I found the following two sites most useful:
Ryan is 8 and a half now and more recently he’s started smearing more (he never fully stopped but we managed to get it down to a handful of incidents a year) – but now it’s become a handful a month again. I’m not sure what the trigger is just yet although the majority of the time it has been when we’ve had family/guests over – so maybe he’s felt like he needed the attention and/or perhaps we were occupied and so he generally didn’t have eyes on him?
The other piece around his smearing is that he doesn’t seem to like poo – which I guess is a great result from when we first started out on this journey! For example, just the other day he was jumping on the trampoline which I guess must have shaken up his stomach, he then was running inside to get to the loo (bless him for knowing what to do and trying!) but was too late – he pooped in his pants. He then sat down on the toilet, took his pants off and threw his pants down – yup, with poo and all (which went EVERYWHERE). He then tried to wipe himself (with the entire loo roll as he hasn’t learnt how to break tissue off just yet), and then when that didn’t do the trick, threw the loo roll down also. He must have gotten poo on his hands (which he clearly didn’t like) and so rubbed then on his legs, the sink, the surface, the towel hanging… anywhere to clean his hands. Oh, and he stepped in some too (must have fallen out of his pants as he hurled it across the bathroom) and so now was rubbing his feet and toes fervently on the floor to get rid of the poo. At that point (and I promise that the above happened in less than 5mins!) my sister and I headed upstairs to see where he was at to discover this…. I kid you not, but it took 5 adults to sort that situation out that day 😂 so thank God for the full house that day!!
I’m still trying to work out the triggers and I’m pretty sure its part diet-related and part behavioural – as well as part trying to wipe himself like any other person would do!
Anyway, so here’s to Stopping the Smearing…. we’re not quite there yet but we’ll get there one day.
Love and hugs
RJ 💜
PS – this photo was taken when the twins were 9days old and still in the SCBU… this was the second time they were together (the first was for a few minutes only as they were wheeled out of the operating theatre and into the SCBU. Strange to think of twins who never actually met each other (or were medically tied/connected) until post birth, however in my case I had fraternal (dizygotic) twins with separate sacs and placentas. Twins (or more appropriately “siblings”) who couldn’t be more different from each other 💜