How to Potty Train a Toddler Who Has OCD

Obsessive Compulsive Disorder (OCD) is uncommon in early childhood, although cases have been documented in children as young as 18 months, according to the Understanding OCD, a Web site. Treating a child is very similar to treating an adult, with cognitive behavioral therapy the gold-standard option. Using CBT, it is possible to train a child to use the toilet, although it will take patience and practice.

Things You'll Need

• Reward Chart

Instructions

1. Determine the items and experiences that motivate your child. Some children with OCD respond extremely well to rewards for successful toilet training, similar to other children. Once your child understands what he is working for, it's possible to use that as part of a ritual to make potty training easier. Use a sticker chart and record successful potty attempts with a special treat at the end of a particular number of successes, determined in advance.

2. Eliminate criticism. Children with OCD react very strongly to criticism and stress. Make the toilet-training program as easy as possible and go as slowly as necessary so as not to bring on an episode. By enriching your child's environment with positive and soothing items, you'll create an atmosphere that makes using the toilet a positive experience.

3. Get rid of the diapers. In her book "The Verbal Behavior Approach," Mary Barbera explains that one of the keys to toilet training children with autism (many of whom exhibit symptoms of OCD) is to have your child wear regular underwear during the day. (Continue to use diapers or pull-ups at night until the child is successfully day trained.) This may be a trigger for a child who does not like messes, so when your child soils herself make sure to clean up immediately and offer positive reinforcement that the mess is nothing to worry about but that she should try to listen better to her body to get to the toilet the next time.

4. Create a program. Working with your child's specific compulsions, you can create a program that will encourage the use of the toilet. If your child fears germs, you can show him how to wash his hands after using the toilet. Let him know that accidents are to be expected and can be easily cleaned up, but do not reward the accident in any way. Behave in a neutral way. Never scold a child with OCD for an accident, as that will likely trigger compulsive behavior. We all use rituals to reward ourselves, and in a child with OCD those rewards can be used to help with toilet training. However, be careful you are not creating a new ritual. (Make washing hands only one time part of the training, for instance.)

5. Schedule potty times. If one of your child's compulsions is to hold urine and not use the bathroom, schedule times for him to use the toilet. Take your child to the bathroom at least every hour, reminding him that using the bathroom is safe and normal. If your child has an accident, react neutrally and clean it up quickly.

6. Listen to and challenge your child's fears. Worry is a common trigger for compulsive behavior. Cognitive behavioral therapy uses those worries as a platform for the therapy by understanding and challenging the belief system. While children may be too young to do this alone, a parent or caregiver can help the child understand the worries and help the child to deconstruct them by simply listening and offering gently challenging questions.

Tips & Warnings

• While a sticker reward chart may work for some children, immediate rewards sometime work best for a child with OCD who needs to have positive reinforcement to calm herself.

• If your child's OCD worsens to the extent that he cannot function, seek medical attention, as medication may be necessary to help your child cope with the disorder.

References

• Understanding OCD
• The Verbal Behavior Approach