Attention or Escape 

 

This is for a 2^nd grader who will not use the bathroom and will go in pants.

 

Antecedent 2 or 3 times a week any setting	Behavior Target	Consequence
Any setting- happens two to three times per week	Has bowel movement in pants	Gave access to a private bathroom anytime. Discussed with parents. Told child parents will have to come and clean them up.

 

 

 

 

 

Antecedent and Setting Event Modifications

 

The first thing to do is ask the parents to come in for a meeting and ensure that there is no medical reason for the child to be defecating in their pants.  Are there any new medications the child is currently taking or have petit mal seizures been ruled out?  Find out if this happens at home and what the parents do when it does happen at home.  Does the child receive a lot of attention or are they sent to their room?  This will be great insight into how the pattern developed if it is occurring at home as well. Did this just appear this year or did this happen in previous years?  What is different about this year if it just started?  Is the work becoming too difficult?  Is there a hidden learning disability that the child is avoiding the stress of by having this behavior? 

 

Once the team is sure that there is absolutely no medical reason for this behavior then the team can collect data on the following:

1. Is there a pattern?
   1. Time of day
   2. Day of the week
   3. After certain food groups
2. What happens after the child defecates?
   1. The child misses something while they are being cleaned up- is there a pattern to what they are missing?
   2. The child gains attention when they are taken to be cleaned up- is the person who cleans them up someone they only see when they are being cleaned up?

                                                               i.      Example: the school nurse or the principal

                                                             ii.      Perhaps the child desires contact with this person and will do anything including defecating to be near this person.

                                                            iii.      I once worked a case like this where a third grade boy was defecating on the boys’ bathroom floor every day. The principal was always called down to supervise his cleaning of the bathroom.  The principal was a male and the child was from a single parent home and never saw his father.  He was relishing the contact he had with the male principal.  Once we put a token economy in place for using the toilet with the tokens earning him free time to go visit the principal every day at the end of the day, he stopped defecating on the floor.  It took less than two weeks to stop the behavior entirely.

3. Once the data collection is complete determine the real reason behind the defecating.  If there is no medical reason, then it is either for attention or escape.  The team will be able to determine the function by what happens in the environment after the child soils his or her pants. The patterns to time of day or day of week will let you know when you need to put the intervention in place. 
4. Never threaten a child with their parents coming up to change their pants.  It may well be that this is exactly what the child wants.  Who wouldn’t want a visit from mom or dad during the day?  If parents get called up to the school to change the pants then the child will continue to do it daily to get that visit.  Proactively, make sure that there is always a change of clothes at school.
   1. One of the biggest challenges behavior specialists face is correctly learned behavior.  Many times when children with autism tantrum, schools have resorted to calling the parents to come get the child.  This teaches the child that if they tantrum long enough, they get to go home for the day. 
   2. The behavior specialist must then go through torture for days of screaming until the child relearns that tantrums will not get them sent home any longer. 
   3. I nearly fainted one day because a child had a tantrum on the bus and the bus driver brought the child back to school.  The bus driver couldn’t reach the mother, so he called the child’s father.  This child only saw his father two weekends a month so he was thrilled to see his father during the middle of the week.  This one event taught the child that having a tantrum on the bus equaled him seeing his father.  Once a habit starts it is very hard to break.

Behavior Teaching

1.  If the function is to gain adult attention then follow this plan for behavior teaching:

a.       Have the nurse teach the child how to clean themselves up when they have an accident.  Have a specific place where the child can go to retrieve:

                                                               i.      Two plastic bags

                                                             ii.      The bag with their change of clothes

                                                            iii.      Underwear

                                                           iv.      Socks

                                                             v.      Pants

                                                           vi.      shirt

                                                          vii.      Fresh Wipes

b.      Tell the child that when they have accidents they need to learn to clean up after themselves.  When the child indicates that they have soiled themselves, the adult will be able to say “Okay, thanks for letting me know.  Go take care of that and be back as soon as you can.” 

c.       You can also follow plan “B” in the next step and the tokens would be used to gain time with an adult of choice.  This adult could eat lunch or play a game with them every three tokens.

2. If the function is to escape an activity then follow this plan for behavior teaching:
   1. Have the child earn tokens by showing someone that their defecation took place in the toilet.  Each time they can show this to someone they earn a token.  (Sorry, you can not take the child’s word for this because they will say it is true ten times a day.)
   2. Three tokens will earn the child a break from the usual task that seemed to be the antecedent to the behavior.

                                                               i.      For example, if it turns out that the child defecated before math three times a week, then three tokens would equal doing their math on the computer for a class period or getting to do every other math problem for that day.

Consequence Modification

Some adults will be saying, “This is ridiculous.  I’m not going to give out tokens for defecating in the toilet.  That kid should just be good and I shouldn’t have to pay off for behavior that everyone else is doing correctly.”  My response would be… “That’s what you are doing now and how is that working out for you?”  You know the saying, “You can lead a horse to water, but you can’t make them drink.”  Well…..”You can lead a child to the toilet but you can’t defecate for them.” 

 

The payoff will be that the adult will ignore the defecation in the pants as much as possible which is why we are going to teach the child how to clean themselves up with minimal adult assistance or we are going to pay off for appropriate bathroom use by giving tokens and attention or escape based on the function of the child’s behavior.

 

If you are thinking, I can’t let a second grader clean up because they won’t do a good enough job and they will smell. Don’t worry about this.  If they smell, one of their peers will give them a good dose of “body odor is gross” and they’ll learn to do a more thorough job. 

 

When my daughter was young she came downstairs one morning wearing her tights inside out.  She did this on the weekend but this was a school day.  These were tights that had embroidered hearts all over them so the inside out meant there were strings hanging all over legs.  I just cringed but I knew if I had a fit about it she’d just argue with me.  I said nothing and guess what? Her friends at school told her she looked ridiculous and she turned them right side out before the day was done.

Academically

 

Look for patterns to time of day to determine if the work being required is too difficult or too easy for the child.  Perhaps they will be less creative with body excrement if their day is filled with work that is challenging but not too difficult. 

Long Term Plan

It’s important to not ridicule the child.  Many parents who have children who still wet the bed have tried ridiculing them into being dry and this never works.  It only serves to make the child insecure.  When the child does have an accident, quietly let them know that you are aware and that you know they know what to do.