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Jennifer, School Psychologist
Category: Parenting
Satisfied Customers: 397
Experience:  Collaborative parent consultation on everything from modifying behavior to child development.
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17 year old son has behavior problems. Has problems using restroom

Customer Question

I have a 17 year old son who is blind. We are having difficulties at school and at home with him using the restroom. He wets himself about three times a day. We have been to the doctor and they have told us it is behavior problems. He was born prematurely. Should we keep him diapered and put him on a changing program? It is getting out of control. We are changing his clothes too much.

Submitted: 7 years ago.
Category: Parenting
Expert:  Jennifer replied 7 years ago.

Hello and thanks for using!
I'd suggest you enlist the help of the school counselor / school psychologist at his school if the doctor believes this is a behavioral issue.
You may try a bathroom schedule -- He's to go to the bathroom at set intervals throughout the day (regardless of whether he feels the urge to go). This may help to reduce the accidents he experiences. Keep the focus and positive attention on those times when he uses the bathroom appropriately and avoid too much attention (and negative associations) with those times when he has accidents. Talk with him about what he might be willing to earn on those days when he uses the bathroom appropriately (and doesn't have an accident). They don't have to be large rewards -- choosing a favorite food for dinner, a family activity that night, etc. The school counsellor can help you to write this behavior plan and include his school day as well (including rewards at school). Hopefully this will help to shape the behavior.
If the behavior continues to be a problem, you could turn to diapering. However, this would definitely be moving in the wrong direction as far as self-care and independence go. Try the behavioral modification tactics first and consult with the school personnel to see if they have other strategies worth trying. I wish you the best of luck!

Customer: replied 7 years ago.

When he wets himself at school, he comes home in a diaper. Should we keep him diapered?

Expert:  Jennifer replied 7 years ago.

I wish there was a cut and dry answer for your question. Unfortunately I think it depends on a variety of factors including what behavioral measures you've already tried and your son's current level of functioning.
If this is entirely a behavioral problem, you could opt to keep him diapered only at school. I'm assuming they may even have a policy regarding diapering when this problem arises just for the sake of safety (exposure of bodily fluids to other students). However, once he's at home you could keep the diapers off to see if the natural consequences of having accidents (discomfort, need to clean up) in combination the scheduled bathroom breaks and your positive attention / rewards for appropriate bathroom use are enough to change the behavior. The assumption here is that he's cognitively aware of the cause and effect of his behaviors. I don't know enough about your son to know for certain if he's capable of understanding that connection or able to do the required clean up involved after an accident. If he is, you may have to teach him the first few times so he knows what's involved and from there it will be his responsibility. Check with the school staff -- keeping him diapered at school may be their recommendation (for safety reasons) for now.
One question I should have asked earlier... Is this a new behavior? Has he regressed this way or has he always had difficulty in this area? I ask because if this is a new behavior, you may want to begin looking at what else may be going on that could cause him to regress behaviorally.

Customer: replied 7 years ago.

This is not a new behavior. He has only gone about 4 days without wetting. The school is going to use restraint toilet chair 3 times a day when at school. He will not stay on the toilet and will go on the floor. When someone his helping him on to the toilet he will start to go and get pee on the floor. The school thinks diapers and restraint toilet chair would help. He needs help with getting diapers on. He does not tell the staff when he wets. He does not like diapers but he will keep them on when told to. Maybe it's time to keep him diapered 24/7. What do you think?

Expert:  Jennifer replied 7 years ago.

You could certainly keep him diapered all of the time, but I'd only suggest that if the behavioral modification strategies aren't working and a medical cause has been ruled out with certainty.
Does the setting matter? Does he have accidents at both home and school? Are you noticing any patterns as to when he has more or less accidents in a day? Those are all things to consider when designing a behavior plan around this.
One option would be to keep him diapered while this plan gets going and wait until he's experiencing some success (dry diapers) before trying a day without. That safety net might make everyone more comfortable (including him) as you all get into the habit of monitoring / rewarding the appropriate bathroom behavior you're looking for.