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| Toilet Training Children with Autism: Prerequisites, Protocols and Problem Solving |
| Sunday, May 28, 2006 |
| 9:00 AM–10:20 AM |
| Chicago A-F |
| Area: AUT; Domain: Applied Research |
| Chair: Kimberly Ann Kroeger (Cincinnati Children's Hospital Medical Center, Kelly O'Leary Center for Autism Spectrum Disorders) |
| Abstract: This symposium addresses toilet training issues for children with autism. Toilet training is a critical life skill; incontinence impedes on an individual’s quality of life by restricting socialization opportunities and educational, vocational and residential placements. Selected presentations include reevaluating the “necessary” prerequisites for beginning toilet training with children with autism, an intensive protocol for training, an intervention for teaching initiation training, and assessment and intervention for bowel movement training. All presentations are data driven, provide protocol explanation and include samples of applied case studies. |
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| Reevaluating “Necessary” Prerequisites for Toilet Training Children with Autism. |
| RENE J. SORENSEN-BURNWORTH (Cincinnati Children's Hospital Medical Center, Kelly O'Leary Center for Autism Spectrum Disorders), Kimberly Ann Kroeger (Cincinnati Children's Hospital Medical Center, Kelly O'Leary Center for Autism Spectrum Disorders), Shannon L. Eidman-Sheahan (Cincinnati Children's Hospital Medical Center, Kelly O'Leary Center for Autism Spectrum Disorders), Jamie M. Lentz (Cincinnati Children's Hospital Medical Center, Kelly O'Leary Center for Autism Spectrum Disorders) |
| Abstract: Toilet training for children with autism is often delayed due to a lack of readiness as demonstrated by not meeting traditional prerequisite criteria (e.g., show interest in toileting, show discomfort when soiled). This can lead to more difficulty with training when it does occur given the longer history of incontinence. An intensive toilet training program was used with 6 children (aged 3 to 9 years) diagnosed with autism who did not meet the traditional prerequisite criteria for beginning toilet training. Five of the six children were successfully toilet trained within 7 days. One child withdrew from the program. The child who met the most number of recommended necessary prerequisites required the addition of a brief overcorrection procedure to completely train. Training success demonstrates that there are a number of skills considered prerequisite to begin toilet training that may not be necessary and rather acquired during the course of training. |
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| A Reinforcement-Based Intensive Toileting Training Protocol for Children with Autism: A Model for Training Caregivers. |
| SHANNON L. EIDMAN-SHEAHAN (Cincinnati Children's Hospital Medical Center, Kelly O'Leary Center for Autism Spectrum Disorders), Rene J. Sorensen-Burnworth (Cincinnati Children's Hospital Medical Center, Kelly O'Leary Center for Autism Spectrum Disorders), Kimberly Ann Kroeger (Cincinnati Children's Hospital Medical Center, Kelly O'Leary Center for Autism Spectrum Disorders), Jamie M. Lentz (Cincinnati Children's Hospital Medical Center, Kelly O'Leary Center for Autism Spectrum Disorders) |
| Abstract: An intensive toileting training protocol was developed and modified from the existing empirically derived literature on toilet training individuals with developmental disabilities and applied to training in an outpatient setting. The toilet training program was composed of extended schedule sittings, hydration, graduated guidance, and positive reinforcement for voiding, as well as an educational component for training the primary caregivers of the to-be-trained children. The program has been used to successfully train over 15 children at a hospital affiliated outpatient autism treatment center. Training was initiated by the autism center staff in an intensive 6-hour block within the child’s home; continued training was implemented by the primary caregivers and follow-up consultation was provided via phone. Sample cases are highlighted from each of the training periods and components of the program. |
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| Initiation Training: Decreasing Prompt Dependency for Initiating Voiding. |
| KIMBERLY ANN KROEGER (Cincinnati Children's Hospital Medical Center, Kelly O'Leary Center for Autism Spectrum Disorders), Rene J. Sorensen-Burnworth (Cincinnati Children's Hospital Medical Center, Kelly O'Leary Center for Autism Spectrum Disorders), Shannon L. Eidman-Sheahan (Cincinnati Children's Hospital Medical Center, Kelly O'Leary Center for Autism Spectrum Disorders) |
| Abstract: Toilet training in an intensive model can sometimes lead to prompt dependency where the child waits for a cue in order to initiate the toileting routine. Often cues take the form of an adult providing a reminder, an auditory timer signaling time to void, or scheduled sitting times. A protocol for decreasing prompt dependency and increasing independent initiation of toileting was implemented and empirically evaluated. The protocol consists of scheduled sittings away from the toilet but within proximity to the bathroom and gradual fading of the proximity from the toileting area. Protocol explanation is provided and sample cases highlighted. Data for two children with autism are presented: one child was trained in an intensive training program (faded to initiation training within one day) and one child was schedule trained and maintained over the course of 3 months; both were successful in initiation training to independent toileting. |
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| Functional Assessment and Treatment of Operant Bowel Movement Accidents in an Adolescent with Autism. |
| FRANK R. CICERO (Eden II Programs), Eileen Hopkins (Eden II Programs), Lorenz Neuwirth (Eden II Programs) |
| Abstract: The current presentation will describe and review an assessment procedure and function-based treatment protocol designed to reduce operant-based bowel movement accidents in an adolescent with autism living in a residential group home. Although the individual was trained successfully for urination, he continued to maintain a high level of bowel accidents. After medical issues were ruled out, a functional assessment procedure was designed to determine if the accidents were operant or due to a lack of generalized toilet training. It was determined that the accidents were operant and a function based treatment consisting of reinforcement, extinction and desensitization procedures was initiated. Bowel accidents reduced to near zero levels. Frequency data on accidents and successful toileting will be displayed and discussed. The presenter will stress the importance of assessing the function of bowel movement accidents before implementing a treatment protocol in individuals who are already urination trained. |
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