Strategies for Reducing Urine Accidents
At school, my 12 year old Autistic son was working in class with a speech therapist when he just peed on himself. I was told he had gone to the bathroom before. Then he was told to pick up cards he pushed on the floor. When they turned around he was wet. He had an accident the same day and the day before. How can I help him stop this behavior?
Initially, it is important to rule out any physiological reasons for this behavior by consulting with your child’s pediatrician.
Secondly, it is important to determine the “reason” or “function” of this behavior. For example, does the behavior help the child avoid a non-preferred activity? Is the child seeking attention or trying to communicate something? These questions need to be answered to determine the best intervention. For a minimum of one day, team members can keep track of the behavior (urine accidents) on an ABC chart, ABC tracking helps determine the reason for a behavior. “A” is for antecedent or what happened before the behavior. “B” is for the behavior. “C” is for the consequence or what happened after the urine accident. Completing an ABC chart will help determine if your child is attempting to avoid an activity or task, receive attention or trying to communicate. If the behavior is occurring at home this same procedure can be followed.
Thirdly, establishing a regular bathroom schedule may also be helpful. Taking the child to the bathroom on a consistent schedule for the entire school day for a minimum of 3 days and charting the results will establish a pattern of urine successes.
Determining the “function” or “reason” for the behavior will help to identify strategies to address the behavior. In addition, charting the results of bathroom visits will help to establish a pattern of urine successes. This information can be used to pinpoint when the child is urinating and how often he should have a bathroom break on a regular basis.
- Child's Age: 3-5, 6-10, 11-13
- Planning Effort: Moderate
- Difficulty Level: Moderate
Use of an ABC chart to determine the purpose of the behavior.
A chart to track bathroom visit results in order to establish a pattern of urination.
1. After consulting with your pediatrician, document for a minimum of one day by charting ABC information on the attached chart. Work with the school team to document at school.
2. Use the results to determine if the behavior is avoidance, attention seeking or for communicative intent.
3. If the behavior is determined to be avoidance of academic tasks, the team may explore use of the following strategies:
- Visual Supports provide students with the help they may need in academic situations when work appears to be overwhelming. Use of ‘chunking’ is an example of a visual support that can make work appear ‘doable’. Refer to answers on this site listed in the resource section below for ‘chunking’ and other examples of visual supports.
- Try a “Build Your Own Schedule” strategy (see related resources below), allowing the student to choose the order of the tasks to be completed. This strategy gives the student control over the sequence of activities still within parameters. Providing structured choices within a framework like this can help a student be more receptive to completing non-preferred activities.
4. If the behavior is determined to be for attention all adults working with the child must be very careful of their responses. If an accident occurs, a clean up routine should be established with verbalizations kept to a minimum.
5. If the behavior is determined to be related to communication, be sure the child has a way to communicate his needs, anger, frustration. In this case, the child may be communicating a dislike for the activity. Work with the speech therapist to determine if this is a behavior that occurs often. Exploring some of the strategies listed above may help. In addition establishing a visual schedule of tasks, followed by a preferred activity may also serve to help the student receptively understand and accept non-preferred activities.
6. Establish a regular, consistent daily bathroom schedule. Chart the results of the child’s bathroom visits (specifically urine successes) for a minimum of 3 days. This information can be used to determine how often he should have a bathroom break on a regular basis.
7. As always-seek the opinion of a professional you may be working with such as behavior, speech or occupational therapists.
Documents and Related Resources
Choice Motivation Assessment (related answer on this site)
First Then Cards (related answer on this site)
Developing a Toilet Routine (related answer on this site)
Build Your Own Schedule (related answer on this site)
Visual Chunking for Math Homework (related answer on this site)
Green Dot to Red Dot Visual Chunking Strategy (related answer on this site)
Work Template (PDF)
ABC-sample (Word document)
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