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.     

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.     

Single-Case Evaluation of a Negative Reinforcement Toilet Training Intervention

ABSTRACT

A negative reinforcement intervention was used to toilet train a child with multiple disabilities. The child appeared to actively withhold urinating in the toilet and was unresponsive to two positive reinforcement training programs. Negative reinforcement required that the child remain in the bathroom during toileting opportunities until he urinated properly. In-toilet urinating was achieved on the first day of intervention and the duration of training sessions decreased steadily. Appropriate toileting and an absence of urinary incontinence were documented post-intervention.     

The rate and amount of food intake as determinants of vomiting

Vomiting of nonmedical origin by retarded persons has been found to be greatly influenced by reinforcement procedures. To explicate the possible influence of the rate and amount of food intake, a satiation procedure and a spaced-eating procedure were provided to three profoundly retarded adults with this problem. Vomiting was found to double or triple after satiation for each subject, and to decrease during spaced eating for each subject; the decrease was especially great for the two subjects who learned to eat most slowly after extended spaced eating training. These results suggest that vomiting is caused in large part by excessive stomach loading and can be effectively treated by reducing the eating rate and/or amount of food intake. This generalization may also apply to infants and to the bulimic binge-purge cycle of nonretarded adults.     

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.     

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.     

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-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.     

Continuation of training as a variable influencing the generalization of speech in a retarded child

Imitation and differential reinforcement were applied in training a speech-deficient retarded child 4 separate verbal answers to 4 “everyday” questions. Training was provided in only one setting with one experimenter. After the subject had acquired each answer-response in the training situation, probes for stimulus generalization were given by both the trainer and nontrainers. These probes tested the usage of both trained and nontrained question-answering responses under nontraining conditions. Use of the separately trained responses in nontraining contexts increased as training continued beyond the established learning criteria. A concurrent reinforcement procedure for all 4 answerresponses increased the overall generalization effects across individuals and settings; the use of differential reinforcement of nonverbal responses in the training setting decreased the overall generalization effects.     

Instruction-following behavior of a retarded child and its controlling stimuli

A combination of positive reinforcement and fading of physical guidance was used to teach a profoundly retarded boy specific responses to specific verbal instructions. The design consisted of a multiple baseline of probe data across different verbal instructions. The subject started responding correctly to each verbal instruction as that item was trained in a multiple-baseline order. Generalization did not occur to items that had not yet been trained, nor did it occur to items included to assess generalization. Probes of variations in the verbal instructions, conducted after training was completed, revealed that generalization was minimal except in those cases where the variation consisted of the verb only, the noun only, the noun plus preposition, or where the verb of the instruction was presented last. Training a profoundly retarded 11-yr-old subject to respond to specific verbal instructions did not adequately facilitate the development of a generative instruction-following capability, nor did all verbal elements of the instruction control a specific response.     

Sensory extinction of stereotyped object-dropping: Identification of a reinforcer for skill training

Stereotyped motor behavior, resistant to treatment by nonaversive means, can be effectively reduced by sensory extinction. Sensory extinction is a procedure which can identify the powerful sensory reinforcers maintaining stereotyped behavior. In this single-subject, multiple-baseline experiment, the elimination of auditory feedback to a workshop trainee who was blind and profoundly retarded, extinguished stereotyped object-dropping. Contingent auditory stimulation delivered for a fixed ratio of correct object placements increased correct responding. Results were discussed in terms of the utility of selecting reinforcers on the basis of empirical manipulations, such as sensory extinction, and in terms of self-control versus contingency functions of sensory reinforcement.     

Influence of selected reinforcers on the cardiorespiratory exercise behavior of profoundly mentally retarded youth.

6 profoundly mentally retarded youth were provided a 5-wk. stair-climbing program to improve cardiorespiratory fitness behavior. Three subjects were provided verbal plus food reinforcement and the other three received verbal reinforcement during the intervention phase. Based on the visual inspection of the data, both types of reinforcement increased the number of steps taken and exercise time.     

Training profoundly retarded children to stop crawling

Many profoundly retarded children continue to crawl even though they can walk. Crawling and walking were viewed as two alternative response modes, both reinforced by movement. Children choose the one mode that is easier and faster for them. A training program was designed to increase the ease and speed of walking relative to that of crawling, and consisted of restraint-for-crawling and priming-of-walking. With the program, four retarded children reduced crawling and began to walk instead. When training was discontinued, two children with moderate walking impairment continued to walk rather than crawl. Two children with severe impairment of walking, however, required the occasional use of the restraint procedure to maintain walking as the dominant mode of locomotion. The program was easily administered, required little time, and was effective for all four children.     

MANAGEMENT OF GERIATRIC INCONTINENCE IN NURSING HOMES

A behavioral management system designed to reduce urinary incontinence was evaluated in two nursing homes with a pretest-posttest control group design with repeated measures. The primary components of the system were prompting and contingent social approval/disapproval which required approximately 2.5 minutes per patient per hour to administer. The frequency of correct toileting for experimental subjects increased by approximately 45%. The experimental groups were significantly different from the control groups on both incontinence and correct toileting measures. The results are discussed in view of the management issues inherent in nursing home settings.     

TRAINING MENTALLY RETARDED ADOLESCENTS TO BRUSH THEIR TEETH1

The need for self-care by retarded individuals in behaviors such as brushing teeth led to the development and evaluation of a comprehensive toothbrushing program that included a task analysis and training procedure specific to each component of the task analysis. Eight mentally retarded adolescents, in two groups, individually received acquisition training that included scheduled opportunities for independent performances, verbal instruction, modelling, demonstration, and physical assistance. The first group of four subjects received token plus social reinforcement; the second received only social reinforcement. All eight subjects showed improved toothbrushing behaviors when compared to baseline. Six of the eight subjects correctly performed all toothbrushing steps in two of three consecutive sessions. The study emphasizes the need for systematic program development and evaluation.     

The effects of undergarment type on the urinary continence of toddlers

There is a growing trend toward later toilet training of typically developing children. This trend is a problem for caregivers and professionals who work with young children, because it is associated with a number of costs and health risks in child-care settings. Results of a recent study (Tarbox, Williams, & Friman, 2004) suggest that wearing underwear may facilitate the development of toileting skills. Based on these findings, we examined the effects of wearing disposable diapers, disposable pull-on training pants, and underwear on urinary continence of 5 typically developing toddlers in a child-care setting. Underwear decreased incontinence and increased continent urinations for 2 of the 5 participants, produced no improvement in 2 participants, and when combined with increased fluid intake and longer sitting periods, produced some favorable trends for the 5th participant.     

AN OPERANT TRACKING PROCEDURE IN THE AUDITORY ASSESSMENT OF PROFOUNDLY RETARDED INDIVIDUALS

The present study investigated a discrete-trials, operant tracking and a descending-series procedure for the determination of hearing levels with profoundly retarded individuals. These individuals were previously diagnosed as untestable. Following stimulus-control training with errorless discrimination procedures, hearing levels for each individual were examined with both procedures. For P-1 and P-2, the operant tracking procedure was administered following a descending-series procedure. Both were observed to “track” their own hearing levels. For P-3, the operant tracking procedure was administered first, followed by the descending-series procedure. Although P-3 also “tracked” her own hearing level, more variable responding was observed. Nonetheless, the operant tracking procedure proved quite workable and may provide for improved hearing testing with “difficult-to-test” individuals.     

TEACHING RETARDED WOMEN A CLOTHING SELECTION SKILL USING COMMUNITY NORMS

Five institutionalized retarded women were taught a clothing selection skill to coincide with popular fashion. Normative data concerning popular styles of color-coordinated clothing were collected through observations of women's apparel in a local community. Using a puzzle simulation of a woman with alternative pieces of colored clothing, color coordination training was conducted using modelling, instructions, practice, praise, and feedback to teach popular selections of color combinations. A generalization training component with actual clothing was also included. Training was accompanied by large increases in percentage of popular color selections with the puzzle and actual clothing. The increases maintained over a seven- to 14-week followup period. Time efficiency measures supported the use of the simulation procedure as opposed to total reliance on actual clothing. The results underscore the utility of local norms in community preparation programs and the efficacy of instructional procedures for severely and profoundly retarded persons as part of their participation in the deinstitutionalization movement.     

A comparison of procedures for eliminating self-injurious behavior of retarded adolescents

An attempt was made to eliminate the self-injurious behaviors of four institutionalized, profoundly retarded adolescents. Some of the behaviors studied were: face-slapping, face-banging, hair-pulling, face-scratching, and finger-biting. Three remediative approaches to self-injurious behavior were compared. Elimination of all social consequences of the self-injurious behavior was not effective with the two subjects with whom it was attempted. The same two subjects were exposed to a procedure involving reinforcement of non-self-injurious behavior which was ineffective under no food deprivation and was effective with one of the two subjects under mild food deprivation. Electric-shock punishment eliminated the self-injurious behaviors of all four subjects with whom it was attempted. The results suggested that punishment was more effective than differential reinforcement of non-self-injurious behavior which, in turn, was more effective than extinction through elimination of social consequences. However, the effects of the punishment were usually specific to the setting in which it was administered. In order to eliminate the self-injurious behaviors of severely retarded children, it is apparently necessary to carry out the treatment in many of the settings in which it occurs.     

CORRESPONDENCE TRAINING: AN EXAMPLE OF RULE-GOVERNED BEHAVIOR?

Two groups of six mentally retarded adults were exposed to either a “say/do” correspondence training program or a “do only” reinforcement procedure to evaluate the suggestion of Rogers-Warren and Baer (1976) that reinforcement of the nonverbal target behavior in the absence of the relevant verbal behavior may account for the behavior changes seen in correspondence training. The participants worked in an experimental setting on a variety of manipulatory responses leading to various auditory and visual consequences. Analysis of individual patterns of responding indicated no apparent differences between the groups during training; four individuals in each group appeared to develop generalized correspondence skills. We conclude that the outcome of correspondence training may not necessarily be verbal regulation of behavior as is assumed. Rather, we suggest that the notion of rule-governed behavior can best account for the type of behavior changes seen in correspondence studies.