It s Potty Time! Toilet Training for Children with Autism. Kim Cornman MA Early Foundations: Autism Model & Outreach Project

Transcription

1 It s Potty Time! Toilet Training for Children with Autism Kim Cornman MA Early Foundations: Autism Model & Outreach Project

2 Potty Training and Children with Autism Children with ASD can potty train at the same age as typical children. Children with ASD have particular learning styles and deficits that may necessitate certain strategies in order to toilet train successfully.

3 Awareness of Readiness At least 18 months of age maturation of sphincter muscles No Bowel Movements through the night Dry diapers for at least 1 ½ hours Are you ready?

4 Behaviors that indicate readiness: Squatting Taking off diaper, pull-ups or clothes when wet Hiding in order to have bowel movements Grunting or straining Doing the potty dance

5 Does the child sit and attend for short periods of time? Does the child have activities he or she enjoys (looks at books, singing songs, watches videos) Readiness behaviors that may assist child in toilet training

6 Two approaches Trip-training Method of developing bladder control by regularly accessing toilet on trips. Pros: More casual approach, less stringent Cons: Takes longer & higher probability of accidents/set-backs Rapid Toilet Training by Azrin & Foxx, 1970s Intensive day-long training sessions Pros: Quicker results, less chance of accidents/set-backs Cons: More labor intensive

7 Most successful approach for children with ASD We combined both approaches for a practical, comprehensive method for toilet training, both typically-developing children and those with autism.

8 Preparation Gather materials needed. Take data on patterns of elimination. Gather your team! Begin Phase I

9 Materials you need: Cotton underwear Reinforcing items, activities, toys, edibles Small child s chair Comfortable seating for you!

10 Take Baseline Data Count the number of wet diapers and the time of day for three days in a row. Tally time and when you changed them beside the changing table or in a designated place. Ensure that they are dry throughout the night.

11 Phase I 1 Phase I objective: Child understands that he/she is to eliminate in the toilet. Procedure: 1. He/she sits on toilet with no clothing. 2.Provide/push unlimited liquids of choice. 3.Give social reinforcement for good sitting. 4.When he voids in the toilet, provide LOTS of reinforcement! 5.He/she is allowed to get off toilet and play on floor in restroom for 10 minutes with favorite activity. 6.Repeat procedure again.

12 Phase I considerations Rules: He cannot get off of the toilet for any other reason, other than voiding. Differential reinforcement should be used for good sitting. His favorite reinforcers are saved for voiding in the toilet. It usually takes 30 minutes to 2 hrs. for them to understand he is to void in the toilet. Phase I is complete when he reliably anticipates his voiding by looking for the urine flow and smiling or becoming excited when he has urinated. If he has an accident during the 10 minute interval, sit him back on toilet. When he voids and is taken off the toilet, make the interval of play 9 minutes.

13 What if they won t comply? Remain calm and neutral. Do not discuss the issue or insist on explaining why they should comply. Follow procedures regardless of initial resistance (child usually stops tantruming when they know the procedure will be followed regardless). Deliver reinforcement for following procedurewhile on the potty.

14 Phase II 2 Phase II objective: Child develops independence, and is completely free from relying on prompts to sit and void on toilet. Procedure: 1.Place him/her in a child s chair, next to the toilet, without clothes and wait patiently! 2.Goal: When child feels bladder urgency, he/she will get up from chair and sit and void on toilet. 3.After he completes voiding in the toilet, reinforce heavily. He is put back in the chair to play with favorite toy, enjoy an edible, etc. 4.Remove reinforcement at 10 minute interval and WAIT for initiation.

15 Phase II considerations DO NOT PROMPT at this stage. Even if he wiggles or does potty dance, do not prompt at this stage. If he has an accident, allow him to finish. Have him clean his body and bathroom. Start interval time over, and place him back in chair. Move chair closer to the toilet.

16 Phase II pitfalls and barriers If a child has 3 accidents in the chair in a row, he/she clearly hasn t mastered sitting and urinating in the potty. Slice back to phase I for at least 5 more times of elimination in the toilet. A small percentage of children will pay attention to the wrong cues and become dependent on insignificant cues, prompts, etc. Using a most-to-least prompting strategy with rapid fading of prompts to ensure independence.

17 Phase III 3 Phase III objective: Child generalizes his toileting skills to natural environments. Procedures: 1.Conduct dry pants checks periodically and reinforce. 2.Lengthen the dry pants checks as days go on. 3.If the child has accidents, you may slice back to phase II by moving child closer to the toilet and remove one item of clothing. 4.Provide opportunity for child to initiate toileting in a variety of locations, in different bathrooms, and for different adults.

18 Phase III modifications Once child eliminates in the toilet, and will initiate in certain settings, but not in all. You need to teach a self-management system Like a picture of potty in his schedule or on his book Teach them a sign, picture, or word to initiate in other settings that can translate to all environments. Provide supports for the child for when he needs to urinate in strange settings like target. Examples, adaptive potty chair, potty cushion mom carries, etc.

19 Possible barriers for children with ASD Prompt-dependence: They may learn to associate urinating with inappropriate cues, like verbal prompts, the color of the chair, whether or not the door was open, what clothes they have on, etc. Loss of independent initiation after being taken by an adult. Child must teach a self-management system and a way to communicate their need for help if independent initiation is impossible. Example, what if the door s closed? what if they can t find the bathroom?

20 Night-time training For most children, bladder control during the day will generalize to night. Keep a nightly routine- Limit fluid intake to 2-3 hours before bed. Encourage child to use bathroom before bed. Wake child up very early morning (about 4:00 a.m.) to go and allow them to return to bed.

21 Set-backs It isn t unusual for children to have setbacks after being potty trained for some time. Some reasons may be: Significant change in routine or lifestyle Illness, i.e. bladder infections, kidney infections, stomach viruses, etc.

22 Bowel Training For most children, having a bowel movement in the toilet is considerably more difficult. Purchase special reinforcers for bowel movements in the toilet. Take data on time of day each bowel movement occurs. If child hides to have bowel accidents in his/her underwear, consider sitting him on the potty in his underwear and leaving the room. Cutting a hole in the underwear and placing them on the toilet may help initiate bowel movements on potty.

23 Case Study: Jack Day 1 Phase I Sit- 9:00 (began drinking) Interval of time off potty between voids- 6 minutes Self-management supports picture of potty on PECS book # of voids until anticipating urination 5 Duration of time on Phase 1: 1 full day

24 Jack continued: Day 2 Phase II Sit-in cube chair, next to toilet 9:00 Interval of time off the toilet-(approximately 10 minutes, but it was at his discretion) Self-management tools/supports-pecs book had toilet picture on it Duration of Phase 2: 1 full day

25 Jack continued: Day 3 - Phase II (Increasing distance) Sit-chair is farther away, adding clothes each successful void Interval of time between voids: approximately 30 minutes As he stood up, prompt to initiate with PECS icon I want to potty. Home strategy: moved chair to hallway

26 Jack continued: Day 4-Phase III continued: Don t push liquids Dry-pants checks plus reinforcement Wait for initiation and then provided assistance

27 Jack continued: Day 5-Phase III continued: Lengthened dry-pants checks to 1 ½ hrs. He was spontaneously initiating toileting in play groups throughout the day. Set-backs: Mom took him to the potty when she thought he needed to go. (Sliced back to Phase 3 for a few days) Duration of Phase III 2 days

28 Questions/Comments

29 Resources: Azrin & Foxx, Toilet Training in Less than a Day, Leaf & McEachin, Work in Progress, www. nationalautismresources.com/azandfototri.html www. Pottytrainingconcepts.com