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My most embarrassing sticker chart story


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If you've known me for more than a few months, you've probably figured out that I kind of hate sticker charts. I do rarely find myself using them for really straight-forward, low-stakes goals if the only problem is that there's a lack of motivation and the person needs a visual representation. Because I'm so confident when I say that sticker charts suck, some might mistakenly assume that I've never used them.


False!


It's important for me to convey to anyone who benefits from my expertise that more often than not, I'm offering advice as a result of learning from my own mistakes. So here goes my cringiest anecdote of using a sticker chart, and my reflections on why it didn't work.


Picture this! Mid-twenties Stephanie in her first field practicum placement at an elementary school. My supervisor already thought I was a rock star. Over a decade later we still keep in touch because she basically talked me out of dropping out of my PhD program (by listening empathically instead of deliberately trying to talk me out of it… but that's a post for a different day). So I was eager and ready to dazzle her and the rest of the school team with my genius!


I was presented with a most odd case of a "typically developing" kindergartener who still used diapers. No other noticeable anomalies in his development; super bright kid; fully aware that he was the only kid in his class who pooped in a diaper. On the outside, he really couldn't care less.


"I know what he needs!" I boldly proclaimed during the team meeting. "Has anyone given him a sticker chart for using the toilet?" I had just finished my graduate course on behavior analysis, so I was ready to do some revolutionary work here. It's unclear to me how others responded, but I proceeded as follows:


  • Offer one sticker for every time he comes into the nurse's office and sits on the toilet

  • After three stickers, he gets a prize


It's real cute that I thought that was going to work. If you too have fallen for this shenanigans, then you likely see where this is going…I'll keep it brief:


  • He would come in, take off his diaper, and just barely touch the toilet with his bottom, and then get right off. Technically he sat on the toilet, so he demanded a sticker.

  • The prizes we had available excited him for all of three days before he stopped caring, or asked for nicer prizes.


*Cracks knuckles* Okay kid. I'm a PhD student at a super competitive university. I've had harder cases than this! I'm smart! I know how to make you use the toilet!


  • Offer one sticker for sitting on the toilet for ten seconds (then eventually work our way up to 30 seconds)

  • After five stickers, he gets a nicer prize


Are you not yet embarrassed for me? I still remember the complete and utter hot-faced fury I felt the first time he sat on the toilet for 30 seconds, got off, then proceeded to poop in his diaper. In front of me. That may or may not have been the first day I cried in my supervisor's office.


After a couple more variations of this, we finally invited his parents in to talk more about what was going on at home and whether we could up the ante of the sticker chart by adding some parent-funded incentives like pizza or favorite things from home.


This was my first lesson in the importance of involving parents in any and all interventions. And it was a hard one. I will spare you and this parent the specifics. But within minutes it became crystal clear to me that a sticker chart was simply never going to fix this. Because a sticker chart wasn't going to address that:

  1. This kid likely had some other neurodivergence that we were simply not picking up on, which was likely genetic. He needed a full neuropsych assessment.

  2. Little dude had a serious imbalance of autonomy in his life that needed to be addressed before we could even consider real potty training. This was one of the few areas of his life where he had any control, and here we were trying to take that away without first building trust.

  3. He had other health concerns that his parents forgot to disclose, which included bowel issues.

  4. We, the adults in charge, were already discouraged and frustrated and we were doing nothing to check ourselves before interacting with him.


It's not that sticker charts were designed by some evil force to drive parents and well-meaning adults to madness. It's just that they only target one aspect of the complete picture: the behavior itself. It treats the behavior like the only part of the "problem" when the reality is that the "problem" is rarely ever that simple. Sticker charts give tired, demoralized adults an invitation to ignore:

  1. Environmental factors in the home.

  2. Mental health history, including early childhood development.

  3. Psychobiological factors such as illness or other bodily anomalies.

  4. Their own energy levels as they try to steer said child into a better direction.


Here we were as a team focusing on why this kid was being such a jerk and willfully pooping in a diaper, wondering why he wasn't moved by some arbitrary external motivator. Whew! We were all missing the point.


This is why I often like to educate parents about the realities of behavior-focused strategies (think positive reinforcement, punishment, response-cost, which I will explain another time): these principles of behaviorism were discovered by manipulating lab rats. They were then applied to children in highly controlled settings like research labs or schools run by a research team. Almost every parent I've worked with has a demoralizing experience that involves failure with a sticker chart.


I hope my super gross story gives you permission to forgive yourself for not "doing it right" and forgive your child for not "getting better" after using this oversimplified tool. I'd welcome any horror stories you may have!

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