Friday, April 07, 2023

To Be Toilet Trained - What Does It Mean?

 Many years ago, I was waiting with my friend at university for her bus. She’s a wheelchair user, so she took the special bus for disabled people, and I often waited with her, or sometimes joined her to go visit her house. Often, we’d be joined by other disabled students waiting for the same bus.

On this particular day, we were waiting with a friend of my friend who I didn’t know very well, but seemed pretty nice. She was also much more disabled than my friend. My friend could use her hands and transfer in and out of her wheelchair, whereas her friend had just barely enough hand use to pilot her motorized wheelchair and was otherwise pretty completely paralyzed.

She was generally accompanied by an aide, but when the aide had seen her to her bus stop to wait for the bus home, the aide would leave. This was usually fine, but this time, the bus was late. And she confessed to us that she needed to pee, and needed assistance in the bathroom that her aide usually provided. I reluctantly offered that if it was that or pee herself, I’d be willing to help, but clearly that was a last resort - I wasn’t trained and our relationship was such that me helping her that way would be socially awkward. Fortunately, it didn’t come to that.

I mention this story today to talk about the different meaning that being “toilet trained” can mean. By a lot of abled definitions, my friend’s friend wouldn’t be considered toilet trained. If you look up lists of the component skills that a toddler needs in order to be potty trained, generally stuff like walking, sitting on the toilet, being able to clean your genitals and hands, and pulling pants up and down are included - all things she couldn’t do. And yet she regularly went all day at university without wearing a diaper or making a mess in her clothes.

I suggest that there are two distinct kinds of “potty trained”. One is an individual who can use the potty independently, and another is an individual who can use a potty with assistance.

Both types of potty training require some shared skills:

  • Ability to tell if you need to pee or poop

  • Ability to hold pee or poop long enough to be able to make it to the toilet

  • Ability to release pee or poop intentionally once you’re on the toilet

  • Preference for peeing or pooping in the toilet rather than in your clothing

However, there’s also skills that are only relevant to one of the two kinds of potty training. For independent toilet use, these include:

  • Ability to remove enough of your clothing to pee or poop without it getting on your clothes

  • Ability to put those clothes back on to a socially acceptable level

  • Ability to get yourself to the bathroom independently

  • Ability to get on and off the toilet independently

  • Ability to wash your genitals and any body part that touched your genitals while they were dirty

For assisted toilet use, there’s only one skill specific to this method:

  • Ability to communicate the need to pee or poop to a caregiver or assistant

For abled NT toddlers, eventually they’ll have all of the above skills, and be capable of both assisted and unassisted toilet use. For many disabled people, only one of the two kinds of potty training might be accessible to them. But even abled NT children might be capable of one kind of potty training before they are capable of the other kind.

A common criticism of elimination communication is to claim “it’s not the baby that’s trained, but the parents”. What they seem to mean by this is that the parents have learned the baby’s cues, but the baby doesn’t actually have the skills to use the potty without the help of an attentive parent.

However, isn’t that just assisted toilet use? Whether it’s someone saying “I need to pee”, making a pee-specific whine and wiggling, or starting to crawl towards the toilet, either way, if they’re telling a caregiver or assistant that they need to pee, holding their pee long enough for that person to help them to the toilet, and then releasing pee once they’ve on the toilet, I’d call that toilet trained. Sure, they might not be able to use the toilet in the absence of appropriate supports, but that’s true for all of us. For example, if the toilet door is locked and I don’t have a key, I can’t use it either.

Conversely, I also see parents saying “I don’t know when my child is peeing, and they’re speech delayed. Is it possible to potty train them?” To which I have to say, if they can’t communicate their toilet needs to you, it doesn’t mean that they can’t use the toilet independently, if they have the necessary skills for independent toilet use. (Teaching them how to do so may be more complicated, though, especially if they have trouble with receptive language. But it’s not unattainable.)

And this isn’t even getting into some of the alternate modes of elimination that some disabled people have. For some people, peeing voluntarily doesn’t involve flexing and releasing muscles in our pelvic floor, but rather sliding a catheter up your urethra to drain your bladder artificially. Someone who can do that or tell a caregiver to do that, and doesn’t leak urine into their clothes (including a diaper) when they have appropriate support, would be considered toilet trained for urine, even though they have an unconventional means of peeing.

So, here’s my all-encompassing definition of toilet trained: someone who can, with appropriate support, consistently refrain from peeing or pooping in any context other than in a specific place designed for the purpose.