Below you will find the actual text conversation between one of our AnswersNow clinicians and a parent.
This was from early on at AnswersNow when we were testing the effectiveness of simple text-to-text communication.
The technique the clinician outlined is a well-understood behavioral mechanism called “desensitization.”
It’s used in all kinds of areas but most commonly used when people suffer from anxiety around things like flying, insects, dogs, social situations, etc.
Full disclosure: We deleted non-relevant parts of the conversation, changed the child’s name to protect privacy, and got permission from the clinician and parent to share the following conversation.
One question I have is about public bathrooms with automatic flushing toilets. Daniel is scared of them, and they are everywhere. Any thoughts on how to help desensitize him to the loud noise they make?
Got it. I’ve done this before!
With my guy, he was 15 at the time and we practiced both “being safe in the bathroom.” For example, looking straight ahead or down, not talking to others, not exploring in stalls, just taking care of business and leaving and worked on desensitization to the sounds of the automatic flushers at the same time.
I did this at lots of men’s rooms, all with automatic flushers and lots of elevators located near the men’s rooms, which were / are this guy’s #1 reinforcers.
We would practice walking into the men’s room, “being safe” and keeping calm and then walking about 5 feet into the men’s room. If he could do that, we immediately got on the elevator and went for a ride.
Repeated: each time adding a bit more distance, but also adding more activities. For example, using the urinal / pretending to use the urinal if he didn’t need to, washing hands, etc. And then following up with a trip on the elevator following every success.
No success: looking around, exploring stalls, appearing / acting uncomfortable re: the flushers. There would be no elevator ride after this.
It took about 3 1-hour practice sessions, but we got there.
I did boosters after thats about once every two weeks for a while, then once a month, then once every 3 months.
Now, neither thing - “being safe” or the sensitivity to the flushers - is an issue any more.
Is this something you can adapt to use with your son?
You’d need a location with a lot of men’s rooms with automatic flushers and, preferably, a man to do this with him. Malls, universities, etc., don’t take kindly to ladies entering the men’s room.
Yes. Possibly. Except that I can't go in the men's room.
But he's young so I still take him in with me, but he is getting too old.
I need to come up with a reward. iPad is his favorite. His dad would work with him too.
Got it. iPad could work. You’d need to bring it with you.
Any chance you can enlist the help of a gentleman to help with this? It’s really essential that someone accompany him to ensure that you’re reinforcing only when he’s “gotten it right.”
His dad would be great and a natural choice.
Sometimes it’s good to practice a general behavior like “being okay.” You can define what being okay is, but generally it would involve appearing and acting calm and getting through a situation.
Yeah.. I think he would try. We have only ever worked on it when he has to go. I usually go in with him and cover the sensor so it won't flush on him.
Outside of the trouble situation, you could practice “being okay,” and reinforce being calm, making a game of it. And then work in mildly annoying situations and prompt and reinforce “being okay” and really talking up those times when you catch your son “being okay.” Because I’ll bet he already does this sometimes.
Daniel’s father helping would be natural. This is a great thing for a father to handle.
Yeah. He does pretty well in the bathroom except the automatic flusher thing. And we have been working on not dropping your pants all the way to the floor when he pees. Lol.
How far apart do you recommend the sessions be?
For some issues like this one, it’s really important to practice when it’s not time to “get it right.” It takes all of the pressure off. Kind of like not waiting until you need to get your son in the car to drop him off so you can get to work to teach him to tie shoes at that moment, we practice that when it’s not so crucial that it be done correctly at that moment, so there’s no pressure, and we can take our time and get it right.
I practiced with my guy at sessions that were a week apart. It worked out well.
Ok. I'll see if his dad will give it a shot this weekend.
He has him two weekends in a row so that could be good.
Beautiful. The key to this is being really clear with what gets the iPad - only good performances.
So, initially, Daniel could walk only 5 feet into the men’s room and exit, and if he’s “being okay,” regardless of whether there were any automatic flushers going, he gets the iPad.
It’s important to start off with a few successes.
Ok. We can do that.
Great! Let me know how things work!
Hey. Just checking in. How are things going?
Good. We actually had a huge success with the automatic toilet desensitization.
We did our first time today because we had a snow storm last weekend and couldn't get out.
I told Daniel what we were going to do, and at first he was on board, but when we got ready to leave he started getting really anxious and crying.
We made it to parking lot, and I had been explaining that we would do it in steps.
First step was just going into the bathroom. At some point it sank in and he said "I don't have to use the potty?" and then he was fine.
We went in and at first he was covering his ears, but he was ok. Then he didn't have to cover his ears. Then we moved into the stall. First covering ears then not.
Then I demonstrated how you moving away causes the toilet to flush. Then he tried just standing in front of it and moving away. I was thrilled with that. Then he said, "let me try this" and he actually peed.
I was blown away!!!
I think we will do the same next weekend, for reinforcement.
I decided to work with him on the automatic flushing thing and let his dad help with the other bathroom etiquette things. Which should be much easier if the anxiety about the flushing is gone.
This is excellent news! Please keep going! Please let me know what I can help with next!