Toilet Troubles. Dyspraxia/DCD.

SIMPLY IMPOSSIBLE.  ( the complications of a seemingly simple task for those with dyspraxia/DCD)

Task 1. Toilet troubles.

Dyspraxia/DCD is a common, lifelong condition which affects some  6% of the population to a significant degree. It affects, fine and gross motor coordination, organisation, perception and thought and sometimes speech and language.

Having lived with a son with a severe degree of the condition for the last 30 years it is fair to say that I have watched him really struggle to manage the most simple of tasks. I have often absolutely ached to do something for him as I observe him desperately trying  to plan and organise himself to make a meaningful movement towards an end goal.  All the things that other people just 'do' have taken a painstaking amount of preparation, execution and practice until the task is mastered. Even then it is extremely difficult for him to transfer that learning into a new set of circumstances and/or environment. When faced with something new, the panic shows, even now. Exhausting for him and exasperating for those offering support. 
I thought I might write a few blogs which explore these seemingly simple tasks so that those supporting/affecting the child can be mindful of the difficulties that dyspraxia imposes upon them.

One of those seemingly simple task is using a toilet successfully. This requires excellent motor and perceptual skills. 

Motor skills are a function, which involve the precise movement of muscles with the intent to perform a specific act. Most purposeful movement requires the ability to "feel" or sense what one's muscles are doing as they perform the act.

Children with dyspraxia often have a compromised perceptual profile.

Perception = the way you take in information through your five senses and make that information meaningful to you. Your Perceptual Style acts as a filter between sensation and understanding. It is at the core of who you are and it impacts greatly on how you function.

Children with dyspraxia require a broad base for balance and so this may require the removal of all the lower clothing in order to sit on a toilet with legs wide apart (remembering that putting those clothes back on is another very difficult process). The child is asked to sit on a large gaping hole (most of us do not have the privilege of a child size toilet) and this can result in an unstable child teetering over that very a large hole, feet swinging in the air and clinging onto the sides of the bowl for dear life.

Motor and perceptual differences  have far reaching repercussions. Poor depth perception for example means that the child has no idea how the deep the hole is that he/she is balancing above (how would you like to wee over a well????!!!) .

We now have a child sitting on something that may be like a bottomless pit, legs dangling affording no base for balance or proprioceptive feedback, and we ask them to 'just quickly use the toilet'.  If they manage that, we then ask them to wipe an area that they are unable to see, meaning they have to let go of the thing they are hanging onto for security,  because of their  co ordination and balance difficulties. We are almost asking for the impossible. No amount of promises, star charts, bribes or encouragement will help. The child does not have the skills in place to conquer the task in hand.

Such a 'simple' every day task becomes a daily trauma, and can lead to children refusing to go to the toilet (chronic constipation) and/or developing real phobias around defecation. 

We MUST be mindful of what we are asking and break the task down in our heads into it's component parts and try to visualise the task through the eyes of the child who views the world differently and live in an unstable and unpredictable environment.

What might we do to help?

Try some bottom wiping movements. For us it was passing things to each other through our legs, replicating the wiping motions of a hand . Goodness knows what an observant window cleaner would have thought as I passed tins of beans from cupboards to children between my legs!

Choose clothes that are easy to remove, like jogging bottoms and something with a logo on the front to make dressing easier. School trousers might have flies replaced with a velcro strip or a strip down one side seam for ease of removal. Choose velcro or slip on shoes and socks with coloured toes and heels for good visual reference.

 

Adapt the toilet to give the child somewhere to plant their feet (flat) and has handles to hold for support and security . If your child is lucky enough to work with an occupational therapist ask his or her advice. 

Use some moist toilet tissue for cleansing and let the child master one thing at a time.  Removing clothes quickly and easily could be a good first step and then perhaps sitting still and securely could be  the next.........until the whole process is mastered. This will take time and patience and positive reinforcement.

Have a good routine, perhaps 'train' a bowel action in the evening at home with a good high fibre tea, and then the child can go straight into the shower afterwards. This also saves the problems faced with using an often busy (and stressful) toilet block at school. 

Don't force the issue. Because others say it is time that your child should be doing something doesn't make them right. Remember your child is an expert and being him/her and children with dyspraxia tend to take longer to master things and may be older than their peers when they do so. That is just fine. Life is not a race. 

Info re bowel training https://www.aboutconstipation.org/bowel-retraining.html

Proprioception = Proprioception (or kinesthesia) is the sense though which we perceive the position and movement of our body, including our sense of equilibrium and balance