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.     

THE MANAGEMENT OF DEHYDRATION AND INCONTINENCE IN NONAMBULATORY GERIATRIC PATIENTS

We evaluated a health care routine designed to decrease incontinence and improve the hydration level of nonambulatory nursing home patients. To implement this routine, a 3′ × 4′ cart was equipped with liquids and toileting equipment. A nurse's aid was assigned the task of taking the cart to each nonambulatory resident in a nursing home and offering specified assistance on a regular basis. Data demonstrated a decrease in physical dehydration, as well as in fecal and urinary incontinence.     

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.     

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.     

Information processing of letter and word pairs as a function of on and off times

The present study seeks to extend a provisional model of visual information processing with sequential inputs currently under development, employing a computer-based cathode-ray tube display system. Letter and word pairs were presented for 28 different on-off time combinations with on times ranging from 5 msec to 50 msec and off times ranging from 1 msec to 125 msec. The results suggest that both on, off, and total processing times affect per cent correct detections, and that while a gradual increase in per cent correct detections occurs up to about 50 msec of total processing time, a marked discontinuity appears to occur approximately between 50 and 60 msec of total processing time, with per cent correct detections jumping abruptly from about 40% correct detections to about 90% correct detections over a total processing time span of only 10 msec.     

Anger management therapy with young male offenders: An evaluation of treatment outcome

The aim of the present study was to assess the effectiveness of a brief group‐based anger management intervention with young male offenders. Eighty‐seven prisoners were assessed as suitable for the intervention. Fifty of these made up the experimental group and 37 the control. Prior to intervention prisoners completed a self‐report anger questionnaire (Anger Management Assessment questionnaire: AMA). Prisoners were also assessed by officers on a checklist addressing angry behaviour (Wing Behaviour Checklist: WBC). Both measures were completed approximately two weeks before the date of the intervention and eight weeks after the intervention (and while the control group remained on the waiting list). It was predicted that the experimental group would show significant improvements in both measures following intervention and that no such change would be observed in the control group. This hypothesis was supported, with significant improvements observed in the experimental group and no change observed in the control. Aggr. Behav. 30:174–185, 2004. © 2004 Wiley‐Liss, Inc.     

Inpatient intervention for chronic functional encopresis in psychiatrically disturbed children

Twelve children referred for short-term inpatient psychiatric treatment also received intervention for Functional Encopresis. Treatment consisted of an initial regimen of cathartic medication (CATH MED) followed by prompted toileting trips after meals for bowel retraining (TRIPS). Maintenance medications were given throughout both conditions. Staff records were used to document the integrity and impact of treatment. Compared to baseline, CATH MED was associated with an increase in independent toileting but no reduction in accidents. Significant improvements were obtained on both of these measures during the subsequent TRIPS condition. Some association among demographic, integrity, and outcome measures was detected. There was modest evidence for maintenance of improvements at one-year follow-up. Implications for the delivery and evaluation of inpatient treatment for encopretic children are discussed.     

A kinesthesiometer for assessing digital passive movement sensitivity in man

An electromechanical system for the delivery of kinesthetic stimulation to human digits is described. The system provides highly precise control over angular velocity (in degrees per second), angular displacement (in degrees), and stimulus duration (in seconds) and uses an electromagnetic brake to terminate the stimuli. It also permits three measures of passive movement sensitivity to be made: correct detections, response time, and angular displacement.     

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.     

危机管理在急诊护理管理中的应用

本文概述了急诊护理危机管理的含义,分析了当前急诊科护理危机的隐患因素,并进一步探讨危机管理在急诊护理管理中应用时的具体措施。阐述了强化危机管理在现代急诊护理管理中的重要作用,提出应最大限度防范与控制急诊护理危机,全面提高急诊科护理管理水平。     

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.     

The span of apprehension: Form Identification as a function of amount of information displayed

Observers were asked to identify each member of a brief display of geometrie forms. The information content of the displays was manipulated by varying the number of forms displayed and the number of relevant dimensions of each form. The main findings were: (a) Performance was approximately invariant with the number of forms displayed and depended to a minor degree upon the relevant information in each form. (b) Serial-position curves were obtained that had a strong primacy effect, (c) The number of correct identifications per trial was approximately normally distributed, with greater variance than if the forms were independentlyidentified.These findings are discussed in relation to both “coding rate” and “memory capacity” models of immediate visual memory. Neither model accounts for the data. Undetermined organizational factors are suggested to play a role in immediate visual memory. This task appears to depend upon form Identification processes different from those indicated by RT measures.     

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.     

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.     

Stimulus control in a two-choice discrimination procedure

The relation between performance during discriminative training and subsequently obtained measures of stimulus control was investigated. Pigeons served as experimental subjects. In the discriminative training phase, a single peck on the center key, transilluminated by a bright or dim white light, resulted in the onset of the side keys, one red and one green. If the center key was brightly lighted, a response on the red side key was correct. A response on the green side key was correct if the center key was dimly lighted. Correct responses were reinforced on independently arranged variable-interval schedules. Following discriminative training, tests of stimulus control were administered during which white light of 11 intensities was projected on the center key and responses on the red and green side keys recorded. The proportion of correct responses in the presence of a bright or dim center-key stimulus decreased with decreases in the frequency of reinforcement of correct red or correct green responses, respectively. The slopes of the stimulus control gradients were related to the extent of response bias during training. The greater the bias to respond on the green key, the flatter the gradient showing the proportion of green-key responses to each stimulus and the steeper the corresponding gradient of red-key responses.     

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.     

Self-selection of standards by children: The relative effectiveness of pupil-selected and teacher-selected standards of performance

This study examines the effects of contingent reinforcement under conditions of pupil-selected and teacher-selected performance standards upon pupils' academic response rates. The academic response rate was measured by the number of correct responses emitted per session. Thirty pupils (15 second-graders and 15 third-graders) were randomly assigned to one of three experimental groups, based on matched triplets. One group worked under pupil-selected standards; the second group worked under standards selected by the experimenter with each pupil yoked to a member of the pupil-selected standards groups. Both groups participated in the calculation of their daily earnings. The third group served as a no-contingency control group. Baseline academic response rates on writing and math tasks were determined. During the experimental sessions reinforcement was provided in the form of points which were later traded for tangible rewards. The pupil-selected standards group showed a significantly greater number of correct responses in the writing and math tasks than the externally selected standards group.     

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.     

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.