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.     

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.     

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.     

Development of child autonomy in eating and toilet training: One- to three-year-old Japanese and French children

This study analyses the interface between children's culture and their development as they learn to perform the daily activities of eating and toileting in culturally appropriate ways. Thirty-three Japanese and 36 French children 12-31 months of age and adults' interventions were observed in public day care centres in Tokyo and in Paris. Within the same time frame, a survey was conducted among the adults (parents and nursery staff) to examine their developmental expectations for children. Observations reveal differences between children's learning in the two countries. Toilet training begins at a later age in Japan and is learned more quickly, whereas learning to eat alone begins earlier than in France but is acquired at a slower pace. The analysis of the surveys shows some discrepancy between adults' conceptions and actual interactions. In both countries, the developmental decrease in physical intervention corresponded with the progress of the child, but adult interventions and strategies varied according to the different cultures. The presence of Japanese adults is greater than those in France, but this does not mean that they intervene physically more often. Finally, instrumental independence begins slightly earlier in Japan.     

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.     

Dry-bed training: rapid elimination of childhood enuresis

Enuresis has been treated with moderate effectiveness by the urine-alarm method which requires many weeks of training. The present procedure used a urine-alarm apparatus but added such features as training in inhibiting urination, positive reinforcement for correct urinations, training in rapid awakening, increased fluid intake, increased social motivation to be nonenuretic, self-correction of accidents, and practice in toileting. After one all-night training session, the 24 enuretic children averaged only two bedwettings before achieving fourteen consecutive dry nights and had no major relapses. Little or no reduction in bedwetting occurred within the first two weeks for matched-control enuretics who were given the standard urine-alarm training. The results of a control-procedure showed that the new procedure did not involve Pavlovian conditioning. The new method appears to be a more rapid, effective and different type of treatment for enuresis.     

Social skills: A review of cognitive-behavioral training procedures with children

Thirty-one studies utilizing cognitive-behavioral procedures to train social skills were reviewed. The review was organized around six methodological issues: (a) age of subjects; (b) training procedures; (c) outcome measures; (d) research design; (e) evidence for generalization; and (f) social validation. Suggestions for future applied research are discussed, such as investigations regarding developmental changes in socially skilled behavior, increased use of multiple dependent measures, more intensive programming for generalization, and the establishment of the social importance of the effects of social skills training programs.     

Effectiveness of social skills training with children: A meta-analytic study

This meta-analytic study examined the relative effectiveness of three methods of social skills training with socially isolated children: coaching, interpersonal cognitive problem solving, and modelling. An exhaustive search of the published literature in the area produced a total of 43 studies that met stringent criteria for inclusion in the subsequent analysis. Social skills training produced significant improvements in children's levels of social interaction, sociometric status and cognitive problem solving abilities. No training technique produced a significantly greater improvement than either of the others. Isolated children showed larger increases in their levels of social interaction and sociometric status than non-isolate children. Multi-modal training programmes were recommended to capitalize on the independent therapeutic effects which derive from a number of different social skills training techniques.     

Working memory training in typically developing children: A multilevel meta-analysis

Psychonomic Bulletin & Review - Working memory (WM) training in typically developing (TD) children aims to enhance not only performance in memory tasks but also other domain-general cognitive...     

Management of hyperactive children through correspondence training procedures: A preliminary study

This study examined the clinical effects of correspondence training procedures in the management of three hyperactive boys between the ages of seven and 10 years. Two subjects were intervened with the “reinforcement of corresponding reports” procedure: reports about the inhibition of hyperactivity (inattention and overactivity) were reinforced only if they corresponded with the actual inhibition of hyperactivity. The “reinforcement set up contingent upon promises” procedure was used with the third subject: the reinforcer was set up (or displayed) contingent on the patient's promises about the inhibition of hyperactivity in the immediate future, and delivered contingent upon fulfillment of the promise (actual inhibition of hyperactivity). These interventions were programmed in a multipie baseline design across two subjects and a multiple baseline design across two behaviors. A changing-criterion design was also used with all subjects: the nonoccurrence of hyperactivity had to be observed across a pre-established criterion level for the actual delivery of the reinforcer. Consistently higher levels of correspondence occurred during treatment, relative to baseline observations. The results also demonstrated the generalization and maintenance of treatment effects. The use of correspondence training as a potential alternative in the development of hyperactive children's self-control is discussed.     

A discrete-trials/fixed-interval method of discrimination training

An efficient new method of discrimination training is described which has several advantages over older free-operant and discrete-trials procedures. Illustrative data on reversal learning in pigeons and goldfish are presented.     

A rapid assessment of skills in young children with autism

Educational interventions based on the principles of behavior analysis are highly effective for establishing skills in young children with autism. As a first step in program development, the child's current skill level is determined by evaluating performance on tasks drawn from a preestablished curriculum. However, few specific guidelines have been delineated for conducting these skills assessments or interpreting the results. In this study, we evaluated an efficient methodology for conducting skills assessments. Six children who had been diagnosed with autism participated. The relative efficacy of two assessment packages--one containing several reinforcement procedures and one containing several potentially effective prompts--was evaluated across two to three skills for each child using multiple baseline and reversal designs. Results suggested that the methodology was useful for matching targeted skills to appropriate interventions.