Using Unproven Therapies

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The subject of using unproven therapies has come up at our home. Sensi has had some toileting regression this past month. Both with constipation and with soiling her pants. I talked with her Theraplay therapist about options. We can't use Mozart for Modulation as we have done in the past, since she is supposed to refrain from listening therapies after AIT.  We decided to try a two week brushing/joint compression trial.

image via: http://cafebonnie.blogspot.com/2009/10/what-is-wilbarger-protocol-or-brushing.html

I have looked and I have found no proven studies that brushing works. When it was suggested by her Occupational Therapist (OT) the first time, way back almost a year ago, I just ignored the suggestion. I figured we had other things to spend our time on, rather than trying to fit another therapeutic program in our schedule. Sensi's tutor and I have talked at length about unproven therapies and how many people still try them anyway. AIT and brushing are both unproven, but when I look at the idea behind the therapies they both made sense for Sensi at the time.

image via: http://www.especialneeds.com/sensory-motor-vibra-derm-massager-therapy-brush.html

I chose to try brushing since our choices are limited by the previous AIT and the trial is limited.  I figure it can't hurt and if it does help it is worth the time. I also know that there are very strict guidelines on using a brushing protocol for sensory defensiveness. We are not following those guidelines. We are doing what works for Sensi and our family. This entails twice daily brushing her body with a soft brush and then following that with joint compressions. I have both the deluxe brush and the cheap "nail" brush that is found at discount and dollar stores. Sensi has shown no preference for one over the other, but I do give her a choice of brushes before we start. That choice makes her more open to being brushed. I talked with her OT in school and they said that in the course of the school day the staff could fit in a daily brushing session too.

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The aim is to make Sensi more aware of her body so that she pays attention to the need to go and uses the bathroom promptly when this occurs. She has had a history of ignoring her body's needs to void and has been a variable eater. She has no set pattern to her toileting, like some other children. It has been very difficult to toilet train her mostly due to this inattention to her insides. This sensation of your internal organs and awareness of them is called interoception. Apparently, she has a lack in this area and we are trying to help her be more aware. 
We are a week into the two week trial, and I can say that there have been days that I missed a brushing session here and there. That being said, I have seen an improvement in her toileting. I will let you know if there are any huge breakthroughs. Although as you all may know, many of the gains our children make are small and slow. It is when you look back over a month or a year that you see the real progress being made.



resources:

Jessica Davich U of Wisc. Stout studies:
An Examination of Brushing Program for a Child with Sensory Sensitivity
A Comparison of Interventions for Children with Tactile Defensiveness


The_SPD_Companion-Wilbarger-Protocol.html
www.spdbloggernetwork.com/2011/05/18/the-poop-on-interoception/

Success...?

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I've been thinking of taking down the printed up email from our potty training guru this last month. It's posted in the bathroom above the toilet to remind me of what to say and do for SensiGirl while we were potty training. SensiGirl has been successful in toileting for the last month. I mean really no accidents at all. I thought I was going to have to buy a pack of underwear for her every week for the rest of our lives there for a while.

image from: http://shopping.yahoo.com/798704550-girls-brief-panties-6-pack/

 We started potty training in earnest right before she turned 5. We had tried the methods we used for Random Guy for almost a year before that and were having no luck with her. It was a half-hearted attempt I admit it, but really, if SensiGirl couldn't tell me she had to go, how was I going to help her get there in time?
The potty sticker chart meant nothing to her. She didn't care. Sticking to a routine didn't work either. I tried rewards: candy, stickers, toys, etc. No luck, she just didn't seem to care if she pooped her pants. The potty videos from the library were a huge step back. Terrifying Potty Power jesters were not the path to toileting success.
Add in that SensiGirl has been constipated for years, and there is a recipe for frustration. I would give her something because she wouldn't go for days, (since she didn't recognize the need) then she would have to go too much because of the Miralax or apricot juice I gave her. We went round and round with that for quite a few months. I got it to where we were only using the Miralax every other day and the apricot juice on the off days and that was working well. Since she is always growing, the amounts she needs to help her go are a moving target. We are now using a different brand of apricot juice, and also pear juice (in the baby aisle.)
I was loaned the book below from SensiGirl's preschool teacher and it was very helpful. Another bit of knowledge to use in our process.

This book was helpful too:
 http://www.pottytrainingconcepts.com/1843104911.html

I tried Oh Crap! Potty Training , it is an e-book, blog and forum, and I got email access to the trainer. The ability to personally discuss our process and progress with an expert was a great help in getting away from no pull ups during the day. It helped me be really committed to getting through the process and not back tracking as we had done before.
We also started occupational therapy when SensiGirl was almost five and a half. We started listening therapy and listening to Mozart for Modulation helped some, but just as we would get into the groove, the disc rental would be over and we would move on to another disk to follow her listening therapy guidelines.  I discussed this with her therapist and we decided she should listen to that disc for a month. I purchased that disc for our own home use too and tried it again for a whole month to establish the habit before we ended our listening therapy at the occupational therapists' for now.
What has been the final step in it all is recognizing that SensiGirl has trouble with interoception. This is known as the awareness of liquids, solids and gases moving through the internal organs.  I then noticed the accidents she was having were while she was deeply involved in things like watching TV or playing with her iPad. So I made a rule that SensiGirl had to poop before she could do those activities. Luckily these activities are highly motivating and usually are requested after a meal, so much the better for getting her to go. She still chooses a pull up at night about 60% of the time but waking up dry about 90% of the time.
There is no magic thing to accomplish potty training with your SensiKid, but a combination of support and information for you and understanding for your child makes it happen eventually.

resources:
http://www.spdbloggernetwork.com/2011/05/18/the-poop-on-interoception/
Jamie Glowacki @ http://ohcrappottytraining.com/
http://mdenoya.wordpress.com/2011/08/04/navel-gazing/