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.     

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 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.     

A device for recording automatic audio tape recording

Adaptation of a commercially available timer for use as a means of operating an audio tape recorder several times during the day is described. Data on a mother's rates of commanding her children were collected via both physically present observer and recorder methods in order to compare the usefulness of the recordings with direct observation. There was a high positive relationship between observer-recorder command rates, with the observer rates being consistently higher, when data were collected via both methods simultaneously as well as at different points in time.     

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.     

AVTA: a device for automatic vocal transaction analysis

The Automatic Vocal Transaction Analyzer was designed to recognize the pattern of certain variables in spontaneous vocal transactions. In addition, it records these variables directly in a machine-readable form and preserves their sequential relationships. This permits the immediate extraction of data by a digital computer. The AVTA system reliability has been shown to be equal to or better than that of a trained human operator in uncomplicated interaction. The superiority of the machine was demonstrated in complex interactions which tax the information processing abilities of the human observer.     

A comparison of different methods of toilet training the mentally handicapped.

A number of different toilet training methods have recently been described. Ellis' (1963) model of toilet training is used to provide a simple basis for classifying these methods. Two main differences, timing versus regular potting, and intensive individual training versus group training are distinguished. Three toilet training programmes (intensive individual, regular potting; intensive individual, timing; group training, regular potting) are compared with five severely or profoundly mentally retarded children for each method. It is concluded that intensive individual training is more cost-effective than group training and that, although there is no significant difference between the intensive individual regular potting and timing methods, the former is the method of choice as it is slightly less complex. Various practical and theoretical issues arising from these toilet training programmes are discussed, including the need for more detailed study of bladder function and other factors related to the development of continence in such children.     

Learner-centered versus automatic adaptive motor skill training

Three types of training (fixed-difficulty, automatic-adaptive, and learner-centered) were used to teach 18 male and 18 female students a two-dimensional pursuit-tracking task. A 7-min tracking session, in which task difficulty shifted each minute, was used to measure transfer. Although training type did not result in differences in training time, students trained under learner-centered procedures had less tracking error during transfer. Females required on the average twice as much training as mates. During transfer no sex differences were noted. The differences in training time for males and females may reflect previous experience with similar motor-control tasks.