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It has been our experience (3 older child adoptions) that bathroom issues and abused kids tend to go hand in hand. It's about anger and control. I believe it was Deborah Hage who pointed out that you can probably make the undesirable behaviors go away, but without healing the underlying issues, the behaviors will just mutate. Our 14yo daughter came to us at age 6, with eneuresis and encopresis. The bedwetting was no biggie, but the pooping in cups and closets was a shocker! We tried being understanding and patient. It just got worse. Finally we decided to hold her accountable. We put her in the bathtub with her fresh "deposit" and a pair of rubber gloves, paper towels and Lysol. She wailed and protested but she cleaned it up. It was the last time she ever did it. Of course, the anger and control issues continued ! However, at the time, this behavior was so unpleasant (We did develop a warped sense of humor over it) that I don't know that I would do it differently today. I do think it is important to understand what underlies the behavior. On the other end of the spectrum, our now 16 yo daughter came home at age 11 as a bedwetter. We did the plastic sheet routine, held her responsible for stripping the beds, etc. It continued for a couple of years. I finally resorted to Goodnights. She loved them! It didn't bother her in the least to be wearing them at her age. (Both my girls are mild MR) One day, she let it slip that she preferred to wear them; it was easier than getting up at night and going downstairs to the bathroom! We went cold turkey after that, following the advice of Dr. John Rosemond. She had a few accidents after that, but within a very short period of time, she was staying dry all night, every night. I guess the point of my rambling is that you have to tailor your approach, depending on the problem. And , of course, as Louise has pointed out, lots of time.