Motor skill delays and un-potty trained 4.5 year old

[That Is Nice]

My son is not potty trained at 4.5 years old. He has ADHD, SPD, and has seen an OT for significant motor skill delays, both gross and fine. After the free services ended as part of EIS, he then was borderline for going through the school district, but did not quite qualify so I didn't pursue it. I continue to use the exercises and techniques the OT taught us in the two years he saw her.

My son is the only child in his class not potty trained. It is starting to impact him socially at daycare. Other kids have noticed and commented.

The issue is my son can not pull up and pull down elastic waisted pants or pull-ups/underwear. He doesn't have the motor control.

And forget about buttons, snaps, etc. We're just not there yet at all.

There are other delays, as well. At 4.5, he is the only child in his class who can not pedal a tricycle or hold a writing implement (crayon, marker, pencil) with anything more than a fist grasp.

How have you dealt with potty training in children with significant motor skill delays?

[sleet76]

My son (turned 5 in April) has ADHD, possible mild sensory-seeking SPD, and is not motor delayed. He is clumsy, and over-estimates his abilities, but it typical overall motor-wise. I just wanted to lend some support--It seems to me that many times kids with ADHD are slower to potty train, and have accidents much longer than many other kids. My son potty trained (with nearly constant pee and poop accidents--daily or even multiple times per day sometimes) at around age 3.5 or 4. It's hard to really draw a line between potty trained and not potty trained--there were so many accidents. It has just been recently--in the past month or two--that we are down to very occasional accidents. Just a pee here or there, and we haven't had a poop accident in a month or two. I'm not considering us out of the woods yet--he's likely to relapse for a few weeks and have lots of accidents.

So...A long ramble to lend support and suggest that your son's potty problems may be stemming from both ADHD, his motor delays, and SPD, since ADHD alone has been enough here to slow things down significantly. I still do a lot of pulling pants up and down and wiping for my son, also. He can USUALLY get them down on his own, but he's likely to just not do it by forgetting or getting distracted for too long on his way to the potty.

[pimms]

My son was also over age 4 when I finally decided one day that I had enough and he needed to be trained. He has a little more motor control and could pull his own pants up/down (buttoning/zippering took some time), but once I finally focused on it I was surprised how quickly he caught on. The good news about them being older is that they usually have the control part down already (although we don't have the ADHD component), it's just breaking the habit. Will his daycare help? It seems in their best interest to assist him the potty and help with pulling up/down and buttoning if they don't have to change a diaper. Does he want to learn? My son is 7 and I still occassionally help him with wiping. So yours may need assistance in that area too for a while.

In terms of the other motor issues, my son really struggles with balance/coordination, especially compared to his peers. He's always the last to learn how to do things like pedaling (currently gearing up to work on no training wheels), he has the correct grasp for writing/drawing but his coloring is all over the place and finally his writing is coming along. My point being it is a complete work in progress, and had taken a few years to get where we are now. I wouldn't get too deflated at your son's age if those skills are tough. Consistency and practice will go a long way. My son receives a lot of services at school and we supplement privately. Between all the things we have tried, I think yoga exercises and swimming have been the biggest help in the areas of overall strength for him. It's given him more confidence and therefore he will focus on the fine motor more now.

[KCMichigan]

I have twin DDs. They are 4.75 and one is not PT. The other has gross motor delays...so we have sort of the same issues only mine are split between 2 kids!

For PT---we are working with a GI dr and will have a 504 plan in place for an adult to help her at PreK. For her, it is a medical issue and is not a matter of wanting to or not. We talk to her frankly about it and reassure her that everyone learns different skills at different times.

For DD w/ gross motor delays. We have OT/PT through EI then evaled thorugh school at age 3. She did not qualify then BUT at age 4 we reevaled and she qualified. At 3 it was OK to use a fist grip and not be able to button....at 4 it showed a delay.

Have you considered a more recent evaluation? You can rerequest an eval.

If at 4.5 he can not pull up/down pants/ button large buttons, use a crayon to draw basic shapes (circles/lines), or ride a trike it would be a delay. Those are things my DD could not do at jsut over 4 and she got both OT and PT through the schools. Now she can do most of those things, but will be getting PT next fall to make sure she keeps gaining skills.

Also does your insurance cover OT/PT ours covered bi weekly sessions for a year so we did that as well.

[bbsc]

My son is 5.5 and is just recently making some amazing progress with potty issues. My son has motor delays also, and was only recently able to pull his pants down on his own. In January and February of this year, he really got a strong interest in learning how to change his clothes. It took a lot of practice with me, and a lot of interest on his part, but he can now do it reliably. It still does take him a much longer time than you might expect, but he does do it.

We have been working on potty learning for a few weeks now. When we are home, he wears a tee shirt only at this point. And he's learned a technique of just pulling his penis out of his pants to pee. If he pulls down his pants all the way, he will sometimes ask for help to pull them back up.

My son has trouble holding a pencil appropriately, and is unable to pedal a tricycle still. He is signed up to go to a special education preschool class next year, and get OT and PT. I didn't really notice that his delays were significant until this year, so we've just had an evaluation with the school district. I got the process started back in March, and we had the IEP meeting last month.

I have tried potty learning sessions every summer since he was 2.5, and it is just this summer that it has worked. The techniques I've been using are still pretty much the same, but I think that he was not ready the other times.

Hopefully your son doesn't notice the comments from the other preschoolers. When children in the class would ask me why my son was still wearing diapers, I would just say that all kids learn at a different pace.

[That Is Nice]

Originally Posted by bbsc

My son is 5.5 and is just recently making some amazing progress with potty issues. My son has motor delays also, and was only recently able to pull his pants down on his own. In January and February of this year, he really got a strong interest in learning how to change his clothes. It took a lot of practice with me, and a lot of interest on his part, but he can now do it reliably. It still does take him a much longer time than you might expect, but he does do it.

We have been working on potty learning for a few weeks now. When we are home, he wears a tee shirt only at this point. And he's learned a technique of just pulling his penis out of his pants to pee. If he pulls down his pants all the way, he will sometimes ask for help to pull them back up.

My son has trouble holding a pencil appropriately, and is unable to pedal a tricycle still. He is signed up to go to a special education preschool class next year, and get OT and PT. I didn't really notice that his delays were significant until this year, so we've just had an evaluation with the school district. I got the process started back in March, and we had the IEP meeting last month.

I have tried potty learning sessions every summer since he was 2.5, and it is just this summer that it has worked. The techniques I've been using are still pretty much the same, but I think that he was not ready the other times.

Hopefully your son doesn't notice the comments from the other preschoolers. When children in the class would ask me why my son was still wearing diapers, I would just say that all kids learn at a different pace.

Thanks for writing.

Your son sounds so much like my son.

Does your son have hypotonia (very low muscle tone)?

[bbsc]

I do believe that he has hypotonia. His regular pediatrician never noticed, but the OT who evaluated him in June told me that my son has very weak hands, and general weakness throughout his body.

Do you do any special kinds of exercises with your son to help with the hypotonia? The team who did the evaluation recommended signing him up for gymnastics, but I haven't done it yet.

[azgirl]

I'm sorry if this is a dumb question...are you considering your son to not be potty trained because he can't do it himself? My son is 27 months and has gross motor delays. He is probably years away from being able to pull down his undies and sit himself on the potty and then pull up his undies again. I consider him potty trained because he wears underwear, lets us know when he needs to go and holds it if there isn't a bathroom available. He wore undies only the last time we flew somewhere and undies only for a 4 hour road trip...I consider that "potty trained" I read "Diaper Free Before Three" and it really influenced my ideas about pottying...the author's thought being that even a person who can't walk or talk should get to decide/have control over when and where to go to the bathroom...It inspired me to start earlier than some people do with typical kiddos with my not-so-typical kiddo... Now that you mention it, if my son goes to preschool he may be the only kid that needs help to go to the potty ...but he will be the only one not running and jumping too...

In thinking this through I guess I make a distinction between "potty trained" and pottying independently. I think maybe you are specifically talking about pottying independently...so this was probably not helpful at all I felt like it would be nice for my son to be potty trained and then he can become independent someday when he is physically able...even if he was never independent he still doesn't need to use a diaper...

[That Is Nice]

Originally Posted by bbsc

I do believe that he has hypotonia. His regular pediatrician never noticed, but the OT who evaluated him in June told me that my son has very weak hands, and general weakness throughout his body.

Do you do any special kinds of exercises with your son to help with the hypotonia? The team who did the evaluation recommended signing him up for gymnastics, but I haven't done it yet.

Hi! We had a similar experience early on. Our regular ped (who is excellent) did not note the hypotonia or mention it at all to us.

It was suspected by the OT, then confirmed/diagnosed by the developmental pediatrician we saw.

Our OT recommended gymnastics, swimming, and the specific OT exercises she taught me.

Another thing I've done is to not cave in to my son. My son, at 4.5, would prefer to sit in a stroller and be pushed if we are walking somewhere...although he won't sit still or stay in it for long (the ADHD) but he will rest in it. Instead, I never bring a stroller anywhere. I make my son walk and we also go on family hikes a lot, on hilly terrain. I am going to build up the endurance and muscle tone over time. I've seen improvements in endurance since giving up the stroller.

But the gross and fine motor skill delays persist.

[That Is Nice]

Originally Posted by azgirl

I'm sorry if this is a dumb question...are you considering your son to not be potty trained because he can't do it himself? My son is 27 months and has gross motor delays. He is probably years away from being able to pull down his undies and sit himself on the potty and then pull up his undies again. I consider him potty trained because he wears underwear, lets us know when he needs to go and holds it if there isn't a bathroom available. He wore undies only the last time we flew somewhere and undies only for a 4 hour road trip...I consider that "potty trained" I read "Diaper Free Before Three" and it really influenced my ideas about pottying...the author's thought being that even a person who can't walk or talk should get to decide/have control over when and where to go to the bathroom...It inspired me to start earlier than some people do with typical kiddos with my not-so-typical kiddo... Now that you mention it, if my son goes to preschool he may be the only kid that needs help to go to the potty ...but he will be the only one not running and jumping too...

In thinking this through I guess I make a distinction between "potty trained" and pottying independently. I think maybe you are specifically talking about pottying independently...so this was probably not helpful at all I felt like it would be nice for my son to be potty trained and then he can become independent someday when he is physically able...even if he was never independent he still doesn't need to use a diaper...

Thanks for this post!

If I define potty training in those terms (let's me know ahead of time, goes in the potty), then, yes, my son is potty trained and has been for a while.

It's quite easy (most of the time) when we're home together. My son will (again, most of the time) say he has to go to the bathroom, and if I'm there to assist with the pulling down/pulling up, he goes and is quite proud of himself.

So, yeah, he's potty trained in that sense.

At school/daycare it's another story. He is very slow about pulling up/pulling down his pants, and it's difficult for him, and takes him much longer than the other kids and the alotted time by the teachers. So, he doesn't bother with it and basically hides it and goes in his pants. He'd rather deal with the teachers being disappointed in him than have to publicly struggle in the group bathroom at daycare.

[LynnS6]

Originally Posted by That Is Nice

At school/daycare it's another story. He is very slow about pulling up/pulling down his pants, and it's difficult for him, and takes him much longer than the other kids and the allotted time by the teachers. So, he doesn't bother with it and basically hides it and goes in his pants. He'd rather deal with the teachers being disappointed in him than have to publicly struggle in the group bathroom at daycare.

I would gently suggest again that this is not the best environment for your son. My kids were in daycare, and they never, ever rushed kids in going to the bathroom. They gave the help that was needed. Ds had fine motor delays and they were willing to work with him on that.

What is he getting out of this environment that you're afraid to lose if you move him to a nice home daycare? A home daycare with someone who can give him a bit more personal attention, more time and one on one attention might be just the ticket for him to make some progress.

Kids need someone who's willing to work with them and show them what to do. They need an emotionally safe environment. Is your daycare providing that?

[That Is Nice]

Originally Posted by LynnS6

I would gently suggest again that this is not the best environment for your son. My kids were in daycare, and they never, ever rushed kids in going to the bathroom. They gave the help that was needed. Ds had fine motor delays and they were willing to work with him on that.

What is he getting out of this environment that you're afraid to lose if you move him to a nice home daycare? A home daycare with someone who can give him a bit more personal attention, more time and one on one attention might be just the ticket for him to make some progress.

Kids need someone who's willing to work with them and show them what to do. They need an emotionally safe environment. Is your daycare providing that?

Well, that is a good question. Honestly, it comes down to schedule. I need a daycare where I can add hours and days when I have meetings and when I have to travel for work. It's pure logistics, from that standpoint.

I work a job that requires meetings on unpredictable days and travel.

DH works a job where he often - both his choice and mandated - stays long days (10 / 12 hours). He gets almost no time off, and he it's normal for him for 6 months to go by without him using any vacation or sick leave.

We don't have any existing family support system.

So, structured day care it is. I can't have an inhome situation where the other person might not be able to accommodate us spur of the moment because they have their own kids, etc to think of. I need a business with operating hours.

Sad, but true.

Other than that, I'd say the teachers at his existing place do give him one on one, when they can, and mean well. But the classroom size and the age doesn't really facilitate that.

Aside from that, there are many benefits to where he does go. It's an excellent school, otherwise, and the curriculum is very beneficial to him.

If work variables were different, however, I might choose a different arrangement.

[laurata]

No advice. My ds has ASD but does NOT have motor delays, except possibly some fine motor (but not enough that the school district is concerned yet). He only just seems to have mastered pottying in the past 3-6 months. For him, he just didn't seem to notice when he had wet or soiled himself, in addition to not have the bowel and bladder control yet.

ETA: Is there some reason they can't help him with his clothes? It *is* a tricky skill to master.

[lolar2]

He might be able to get more help when he goes to public school, because it can go into his accommodation plan if an evaluation supports it. Is there maybe a public pre-K plus after-care that would have similar hours?

[laurata]

Originally Posted by lolar2

He might be able to get more help when he goes to public school, because it can go into his accommodation plan if an evaluation supports it. Is there maybe a public pre-K plus after-care that would have similar hours?

OR, is it possible that he could attend a public pre-K and your provider would be willing to pick him up/ drop off? I know many kids in my son's preschool rode buses or "Kiddie Cabs" to after school care.

[That Is Nice]

Originally Posted by laurata

OR, is it possible that he could attend a public pre-K and your provider would be willing to pick him up/ drop off? I know many kids in my son's preschool rode buses or "Kiddie Cabs" to after school care.

I would LOVE if he could attend public pre-K, but, alas, we have no such option here. Public pre-K doesn't exist here. It's a real shame, but for my family personally and as a policy.

I've considered moving to where public pre-K is offered, but the housing and job market is challenging. And I'm sort of running out of time for that option.

[bbsc]

Is your son going to be old enough for K next year? Even if he's not, I think it would be a good idea to try and have him reassessed through the school district.