Toilet training children with sensory impairments in a residential school setting

Acquisition of toileting skills is an essential educational objective for children with developmental disabilities. However, there are few empirical reports of toilet training programs for children who have developmental disabilities and combined sensory impairments. The present studies evaluated toileting programs for two children with multiple disabilities and vision and hearing deficits. The programs featured systematic prompting, scheduling, and reinforcement procedures that were applied in a residential school setting. Each child was successfully habit-trained with results maintained 1–5 months posttraining. One of the children also demonstrated consistent, self-initiated toileting.     

Dry pants: A rapid method of toilet training children

Toilet training sometimes requires considerable time. An intensive learning procedure was devised for shortening this training time and tested with 34 children who were experiencing toilet training problems. The procedure had the following major characteristics: (1) a distraction-free environment, (2) an increased frequency of urination by increased fluid intake, (3) continuous practice and reinforcement of the necessary dressing skills, (4) continuous practice and reinforcement in approaching the toilet, (5) detailed and continuing instruction for each act required in toileting, (6) gradual elimination of the need for reminders to toilet, (7) immediate detection of accidents, (8) a period of required practice in toilet-approach after accidents as well as (9) negative reinforcement for the accident, (10) immediate detection of correct toileting, (11) immediacy of reinforcement for correct toiletings, (12) a multiple reinforcement system including imagined social benefits as well as actual praise, hugging and sweets, (13) continuing reinforcement for having dry pants, (14) learning by imitation, (15) gradual reduction of the need for immediate reinforcement and (16) post-training attention to cleanliness. All 34 children were trained and in an average of 4 hr; children over 26 months old required an average of 2 hr of training. After training, accidents decreased to a near-zero level and remained near zero during 4 months of follow-up. The results suggest that virtually all healthy children who have reached 20 months of age can be toilet trained and within a few hours.     

A rapid method of toilet training the institutionalized retarded

Incontinence is a major unsolved problem in the institutional care of the profoundly retarded. A reinforcement and social analysis of incontinence was used to develop a procedure that would rapidly toilet train retardates and motivate them to remain continent during the day in their ward setting. Nine profoundly retarded adults were given intensive training (median of four days per patient), the distinctive features of which were artificially increasing the frequency of urinations, positive reinforcement of correct toileting but a delay for "accidents", use of new automatic apparatus for signalling elimination, shaping of independent toileting, cleanliness training, and staff reinforcement procedures. Incontinence was reduced immediately by about 90% and eventually decreased to near-zero. These results indicate the present procedure is an effective, rapid, enduring, and administratively feasible solution to the problem of incontinence of the institutionalized retarded.     

Behavioral engineering: two apparatuses for toilet training retarded children

Daytime incontinence is a major problem for retarded children. A training procedure for eliminating this problem should be facilitated by an apparatus that provided the trainer with an immediate signal when the child voided so that the trainer could react immediately. Two apparatuses were developed for this purpose: a toilet-chair apparatus to signal proper toileting and a portable pants-alarm apparatus to signal wetting of the pants. A reprimand was given when pants wetting occurred whereas positive reinforcement was given for proper toileting. Results with four profoundly retarded children indicated the reliability of the apparatuses in practice and the effectiveness of a toilet training program that used the two apparatuses.     

A Review of: “Fairburn,C. G. (2008). Cognitive Behavior Therapy and Eating Disorders.”

Successful reports of behavioral treatment of encopresis describe interventions as unpleasant as the disorder: hospitalization, laxatives, prompted toileting, aversive consequences. The focus on soiling rather than on the constant constipation that precedes encopresis, on the reduction of soiling rather than on the acquisition of effective toilet use. Five normal chronically constipated children (four of whom were encopretic) were treated at home with combinations of: preparatory instructions, rewards for clean pants, reward for appropriate toileting (bowel movement in toilet). Once soiling was eliminated and appropriate bowel movements occured regularly, all families were taught to fade treatment contingencies. To determine the contribution of the toileting reward to treatment effectiveness, this reward was added to the other two treatment components in a multiple baseline across four cases; it provided a significant ingredient in short-term success. A fifth child achieved short-term success with only the instructions and the clean pants reward. Long-term results (11-20 months) revealed that the fifth child, who never received the toileting reward, was the only one who relapsed.     

Caregiver-implemented toilet training procedures for children with autism spectrum disorder

Children with Autism Spectrum Disorder often exhibit deficits in daily living skills, including toileting skills. Previous studies have evaluated components of common toilet training practices, including differential reinforcement, sit schedules, fluid loading, underwear, and wet alarms. The purpose of this study was to replicate and extend previous work by delivering all coaching remotely. Three caregiver-child dyads participated in this study. A researcher coached caregivers on the implementation of the protocol using a modified behavioral skills training approach via telehealth. Caregivers submitted daily toileting data and weekly audio recordings for treatment integrity checks. The sit schedule fading was individualized to meet the needs and preferences of each family. All caregivers implemented the protocol with high integrity. Two participants met the mastery criteria at the 90-min sit schedule and maintained performance at the 1- and 6-week maintenance follow up probes. The third participant, despite an interruption of treatment, also reached mastery.     

Promoting Self-Initiated Toileting in Children with Severe Developmental Disabilities

Abstract

This study assessed the possibility of teaching self-initiated toileting through a programme that (a) allowed the subjects (children with severe developmental disabilities) to remain in their normal contexts and(b) supplied these contexts with toileting cues. Frequent toileting occasions, reinforcement and reprimands were other features of the programme. The results showed that all three children involved in the study acquired self-initiated toileting. Two of them became virtually free from accidents, one continued to have a few accidents. The implications of the results are discussed.     

Dry bed: A rapid method of eliminating bedwetting (enuresis) of the retarded

Bedwetting has been a major and unsolved problem for the severely retarded. To solve this problem, an intensive training program was designed similar to a recently developed program for daytime toilet training of the retarded. Some distinctive features of the new procedure were frequent positive reinforcement for correct toileting, a negative reinforcer for accidents, positive practice in night time toileting, increased level of urination by forcing drinking, immediate detection of correct and incorrect toileting, and Positive Practice for accidents. Of twelve retarded adult bedwetters, the average bedwetter required only one night of intensive training. Several days of apparatus monitoring were used following the training but proved unnecessary for two-thirds of the trainees. Accidents were reduced by about 85 % during the first week after training, and almost entirely (95%) during the fifth week with no relapse during a 3 month follow-up. No reduction of accidents resulted when the same bedwetters were given a control procedure that provided no positive or negative reactions other than the sounding of an alarm upon bedwetting. The Dry-Bed procedure appears to be a very rapid solution to the problem of enuresis among the retarded and may be applicable to other difficult populations and also to normals.     

TEACHING CHILD-CARE SKILLS TO MOTHERS WITH DEVELOPMENTAL DISABILITIES

The present study identified and remediated child-care skill deficits in parents with developmental disabilities to reduce their risk of child neglect. Eleven mothers with developmental disabilities who were considered by social service and child welfare agencies to be providing neglectful child care were found in baseline to have several important child-care skill deficits (e.g., bathing, diaper rash treatment, cleaning baby bottles) compared to nonhandicapped mothers. Parent training (consisting of verbal instructions, pictorial manuals, modeling, feedback, and reinforcement) resulted in rapid acquisition and maintenance of child-care skills in all mothers. Mean percentage correct scores increased from 58% in baseline to 90% in training and 91% in follow-up (M = 31 weeks). The latter two scores compare favorably to the mean score (87%) of 20 nonhandicapped mothers on the same skills. Where observable, parent training was associated with corresponding benefits to the children (e.g., elimination of diaper rash and cradle cap, increased weight gain, successful toilet training). These results indicate that parent training may be a viable option to the removal of the child from the home when parenting skill deficits place the child's well-being in jeopardy.     

Bridging the Divide Between Psychodynamic and Behavioral Approaches for Children with Oppositional Defiant Disorder

ABSTRACT

Oppositional defiant disorder (ODD) is one of the primary reasons youth are referred to mental health services. Disruptive behavior disorders such as ODD are heterogeneous in their presentation, developmental trajectories, and treatment needs. Given the high attrition rates in child psychotherapy in general, there is a need for a range of interventions tailored to meet the unique needs of each family to help increase familial engagement and positive outcomes for children with ODD.

This article outlines composite clinical case material of a child with ODD who was treated with Regulation Focused Psychotherapy for Children (RFP-C), a manualized, psychodynamic intervention for ODD. The case presented is then reconceptualized from a behavioral parent training perspective. This approach uses parent training to encourage positive parenting practices and reduce coercive reinforcement cycles. The case material and its reconceptualization are followed by a discussion of the distinctions between psychodynamic and behavioral approaches to children with ODD. An integrated psychotherapy approach is proposed, and the benefits and challenges of psychotherapy integration are discussed.     

The effect of self-recording and social reinforcement components of parent training programs

This investigation attempted to assess the effectiveness of two components of parent training programs: (1) the effect of a self-behavior management project prior to intervention with deviant child behaviors, and (2) that of social reinforcement from peers and the consultant. Four groups of parents were exposed to a basic training program and were measured on their success in an intervention program in the inappropriate behavior of their children (ages 7–9 years). Two groups of parents were requested to do a self-modification program prior to the intervention with deviant child behavior; two groups did a child intervention program without a self-management project. One group in the self-management and one group without self-management received verbal social reinforcement from peers and the consultant during interventions. Results obtained indicate that the parent group whose training involved a self-behavior management project prior to intervention with their child's inappropriate behavior and verbal social reinforcement achieved a significantly greater reduction of these behaviors when compared to the groups where either self-management of social reinforcement was used.     

An automatic device for toilet training

A chain of subject-initiated toileting behavior was established and maintained in three enuretic and encopretic profoundly retarded adults through the use of an automatic device which both monitored eliminations and dispensed candy reinforcers. When the device reinforced elimination, the incidence of urinations and defecations in clothing was sharply reduced in each subject, while the frequency of appropriate toileting behavior increased. With the device nonoperative (extinction), the behavior relapsed toward pretraining levels. In reconditioning, with the device again functional, post-training levels were re-established. The device was reliable and was seen to eliminate many of the difficulties inherent in toilet training.     

Improving FASD Children’s Self-Regulation: Piloting Phase 1 of the GoFAR Intervention

ABSTRACT

The initial parent training component of GoFAR, an intervention designed to improve the self-regulation and adaptive living skills of children with Fetal Alcohol Spectrum Disorders (FASDs), was piloted in a small, randomized clinical trial of 28 participants assigned to either a time-lapsed control group or one of two parent training groups who differed on whether the child’s computerized instruction was congruent or incongruent with the parent instruction. Parental compliance and achievement of therapy goals were indicators of improvement in the child’s self-regulation skills. Children who received computerized instruction consistent with the parent training demonstrated greater self-regulation improvements than those receiving incongruent computerized instruction.     

Effects of Self-Monitoring Intervention on Independent Completion of a Daily Living Skill for Children With Autism Spectrum Disorders in China

Abstract

The purpose of this study was to investigate the effect of a self-monitoring intervention on the independent completion of dishwashing for three boys with autism (ages 6, 7, and 8) in China. The self-monitoring intervention included visual task analysis, in vivo modeling, self-recording, video self-feedback, and reinforcement. A multiple probe across subjects design was used. Prior to the study, the children had limited or no dishwashing skills, nor did they receive any training on self-monitoring. All three children acquired dishwashing and performed the task independently without supervision one week after the intervention. Their parents were very satisfied with this intervention.     

Internet-based parent management training: a randomized controlled study

ObjectiveThe current study evaluated the efficacy of an Internet-based parent-training program for children with conduct problems. Dose–response ratio and costs for the program were also considered.MethodParents of 104 children (aged 3–12 years) were randomly allocated to either parent training or a waitlist control condition. Diagnostic assessment was conducted at baseline and parent ratings of child externalizing behaviors and parent strategies were completed before and after treatment and at 6-month follow-up.ResultsAt post-treatment assessment, children whose parent(s) had received the intervention showed a greater reduction in conduct problems compared to the waitlist children. Between group intent-to-treat effect sizes (Cohen’s d) on the Eyberg Intensity and Problem scales were .42 and .72, respectively (study completers .66 and 1.08). In addition, parents in the intervention group reported less use of harsh and inconsistent discipline after the treatment, as well as more positive praise. Effects on behavior problems were maintained at 6-month follow-up.ConclusionsThe results support the efficacy of parent training, administered through Internet, with outcomes comparable to many of the group-based parent training programs. The efficacy, low cost, and higher accessibility make this intervention a fitting part in a stepped-care model.     

Toilet training,cueing, praise,and self-cleaning in the treatment of classroom encopresis: A case study

This study was designed to ameliorate encopresis in a 6-year-old male child in the school setting. The procedure consisted of toilet training, cueing, praise, and self-cleaning. Prior to intervention, encopresis was a daily event at home and school. The intervention was successful in reducing the soiling to near zero at school, with no reported changes at home. Implications discussed for school psychologists were: (a) handling the intervention through a consultation model, (b) using the simplest approach before attempting more powerful procedures, and (c) attempting treatment in spite of the fact that other treatment attempts at home had been unsuccessful.     

Improving parent–child interactions through interactive reading workshops

IntroductionMany authors agree on the importance of training parents in early literacy strategies.ObjectiveThis study analyses the effects of an intervention to improve parent–child interactions during reading sessions, using interactive reading techniques.MethodThe design is exploratory and includes a treatment group (n = 22), which benefited from four interactive reading workshops, and a control group (n = 18), which did not benefit from specific training. Both groups read the same books, three times a week, for 10 weeks. The children come from middle socioeconomic backgrounds and attend preschool or kindergarten (grades 1–3).ResultsThe analyses were conducted on the basis of pre- and post-intervention video observations, coded using the Adult–Child Interactive Reading Inventory (ACIRI). Results from an ANCOVA show that parental behavior, and in turn child behavior, improves in post-intervention: parents improve their children's attention to the text and implement literacy strategies, while the children become more involved in the interactions.ConclusionInteractive reading workshops for parents improve the quantity and quality of parent–child interactions when reading books in a natural and playful context.     

An extension of commonly used toilet-training procedures to children with autism spectrum disorder

The current study evaluated a toilet-training treatment package described by Greer et al. (2016) with children diagnosed with autism spectrum disorder (ASD). Most of the current research on toilet-training interventions for children with ASD are replications and modifications of Azrin and Foxx (1971) or (more recently) LeBlanc et al. (2005). However, these procedures are composed of components that are not included in studies with typically developing (TD) children. For example, Greer et al. evaluated the effectiveness of three typical components within a toilet-training package, mostly with TD participants: a 30-min sit schedule, placing participants in underwear, and differential reinforcement. The primary purpose of the current study was to replicate and extend the treatment package described by Greer et al. to children with ASD. A secondary purpose was to evaluate modifications necessary for individualized toilet training when the commonly used components were ineffective. The results of Greer et al. were replicated for 11 participants with ASD in the current study, suggesting that intensive toileting interventions (e.g., interventions requiring overcorrection, reprimands, and dense sit schedules) may only be necessary for a subset of individuals with ASD.     

An above real time training intervention for sport decision making

ObjectivesA speeded video-based decision-making training intervention was used to assess the impact of above real time training on decision-making skill in sport.Design and methodsThree groups completed pre tests and either five weeks of fast speed video training, normal speed video training or no training, followed by a post test and two retention tests in subsequent weeks. Decision accuracy was measured by awarding three, two, one, or no point(s) based on independent coach ratings of each situation.ResultsResults revealed that those trained in above real time improved performance earlier in the training intervention compared to those trained in normal speed. The above real time group also retained more of the performance improvements. The transfer test for decision accuracy showed improvement following the training intervention for all groups, trends in the data reflected a higher retention rate for the fast speed group choosing the bet option more frequently than normal and control groups.ConclusionsThe results lend support to the general use of video-based decision-making training for team invasion sports. A greater impact is that they provide a new paradigm by adapting above real time training to decision making, to create a more game-like training scenario.     

Durable,efficient, and economical electronic toilet-training devices for use with retarded children

Instrumented behavior observation and modification is typically an expensive process, yet the instruments used are often relatively simple and limited in function. Two sets of electronic devices were constructed to aid in training correct toileting behavior with retarded children. The body-worn alerting unit monitors the residents’ elimination as he moves through his environment. This set consists of a moisture detection circuit enclosed in a durable plastic box which is worn by the resident in either a harness or vest. The body-worn alerting unit is connected, via a cord, to underwear which have pliable wires running along their midline. The other set of units monitors elimination on a commode or toilet, and consists of a signaling box containing the moisture-detection circuit and a circular plate which is hung on the toilet or commode. Over 3 years of field testing have shown the units to be very durable and efficient.