6/27/2014
Potty Success: It’s No Accident Kerry Ann Conde Trumpet Behavioral Health
We will discuss: • When to start toilet training • Strategies & guidelines for toilet training • Problem solving common toileting issues
Routine Based Toilet Training • PATIENCE • CONSISTENCY • TEAM WORK • HUMOR
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Readiness check • • • • • • •
Understand and follows simple directions Differentiates wet and dry Understand toileting words Desire for independence Prefers being dry and or clean Can pull pants up and down Family life is calm
Medical Concerns • No medical problems • Constipation, UTI • Always check with your doctor first! • Check with your doctor to make sure it’s safe to start toilet training
When to start • Your child has demonstrated some readiness skills • Follows 1-step instructions • Has a communication method (verbal, PECS, signs) • Can hold urine for a short period of time • You & other caregivers are ready • Time, effort, patience to work on toileting • All on the same page – consistency is key!
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Prepare • Make sure your child likes being in the bathroom • Your child should be able to sit comfortably on the toilet with his/her feet resting on the floor/stepstool
Prepare • Select reinforcers • Highly valued • Only get access for going to the bathroom • Identify communication method • Verbal • Pictures/PECS • Sign language • Identify your child’s unique needs • Sensory issues? noise, flushing the toilet, etc.
Data • Collect data for 5 days • Record the time your child eats, drinks, gets changed, has a soiled/wet diaper • Check his/her diaper at least once per 30 min Time Eat/Drink 7:00 am 7:30 am 8 oz. milk, cereal 8:00 am 9:00 am
Toileting Changed diaper - wet Changed diaper - soiled Checked diaper - dry
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Data • Look for a pattern• 10-15 minutes after having liquids • 30-60 minutes after a meal. • These times can then be built into your routine.
wet
wet
wet
wet
wet
wet
wet wet
wet
wet
wet
wet
wet
wet wet
Create a Toileting Routine • Set a toileting routine • Schedule sits based on your data • Times when child is likely to urinate • Regular intervals in between (every 30 – 60 min)
• Honor the schedule • Set a timer so you always know when it’s time to go • Waiting 15-20 minutes could cause your child to have an accident
Scheduled Sits • Teach communication behavior • “Say, bathroom” – “Bathroom” • Sit on toilet for 2-5 minutes • Provide relaxing toys/activities to prevent boredom • Reinforce successes • Praise, special food or toy, get to flush the toilet
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Unscheduled toileting • Watch for signs• Antsy, legs crossed, touching private parts, wetness • Ask if he/she needs to go to the bathroom • Rush him/her to the toilet
Accidents • If the accident is currently happening: • Rush your child to the toilet to try to convert to a success • If you do convert, provide praise and the reinforcer • If the accident already happened: • Calmly bring the child into the bathroom and assist with changing/cleaning himself/herself • Do not provide attention • Don’t look directly at him/her • Don’t talk, console, hug, etc.
• Don’t punish!
Track Your Progress • Collect data during toilet training
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Track Your Progress 6
Toileting Events
5 4 Success Accident Acc/Succ Conversion
3 2 1 0 1
2
3
4
5 6 Days
7
8
9
10
Low-Tech Alternative Track accidents only – shade in the grid for every accident
Diapers vs. Underwear Diapers/Pull-ups
Underwear
Pros
• Easy to keep clean
Cons
• Difficult to tell if accident is happening • May confuse child (e.g. “diaper is where I’ve always gone pee”)
• Easy to tell if accident is happening • Creates new rules (e.g., “Now I wear underwear and pee in the toilet”) • More mess to clean up
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Summary of Steps • • • •
Ask: Is my child ready for toilet training? Am I ready? Prepare: Get reinforcers, toilet seat, step stool Collect data: Look for patterns Create a toileting schedule: Honor the schedule • Scheduled sits: Teach communication, sit for 2-5 minutes, reinforce success with special toy
• Unscheduled toileting: Watch for signs • Accidents: Don’t punish
Tips • Start by having your child sit on the toilet (even boys) • Helps him/her to relax • Can sometimes get BM continence for free • Make sure everyone is using the same language • Pee, potty, tee-tee, toilet, bathroom • Have your child wear loose-fitting clothing • Easy to take off and on for frequent toileting • Provide your child with extra beverages/fiber
Data/Evaluate 3-6 weeks evaluate: How are things going? Do you need to… • Change reinforcers • If child seems bored/disinterested • Increase intensity • Intensive toilet training? • Take a break • Stay the course
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Intensive Toilet Training • Azrin and Foxx (1971) • Intensive procedure that includes • Scheduled toileting • Reinforcement for urinating in the toilet • Communication training • Dry-pants checks/urine alarm • Increase fluid intake • Positive practice
Problem Solving • My child seems to like having accidents or thinks it’s funny to have accidents • Consider how much attention you provide during accidents • Make toileting more fun • Hit the target • Splash in the sink during hand-washing
Problem Solving • My child sits on the toilet and does nothing then as soon as I put the diaper/pull-up back on he has an accident • He may not understand the new rules • Diapers have a history of being the place where you go to the bathroom • Diapers wick away moisture to make it more comfortable to have an accident • Consider switching to underwear
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Relax… • Don’t stress- but do commit. It’s a marathon not a sprint!
Questions/Concerns
Resources Books (Many to choose from) Tinkle Tunes Websites: www.dcs-cde.ca.gov/toilettraining.pdf (Toilet Training Procedures for Individuals with Dev. Disabilities) pediatrics.about.com/cs/parentingadvice/a/sp_needs_potty.htm (Potty Training Children with Special Needs www.ds-health.com/train.htm (Toilet Training Children with Down Syndrome)
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Potty Success: It’s No Accident! Important Tips When to start toilet training • Is your child ready? • Understand and follows simple directions • Differentiates wet and dry • Understands toileting words • Desires for independence • Prefers being dry and or clean • Can pull pants up and down • Family life is calm • No medical problems! Strategies & guidelines for toilet training • Your child should be able to sit comfortably on the toilet with his/her feet resting on the floor/stepstool • Prepare: • Get reinforcers, toilet seat, step stool • Collect data: • Look for patterns • Create a toileting schedule: • Honor the schedule • Scheduled sits: • Teach communication, sit for 2-5 minutes, reinforce success with special toy • Unscheduled toileting: • Watch for signs • Accidents: • Don’t punish • Collect data during toilet training: • 3-6 weeks evaluate: How are things going? Problem solving common toileting issues • Don’t stress, but do commit. It’s a marathon not a sprint!
Toileting Resources Books Azrin, N. H., & Foxx, R. M. (1976). Toilet training in less than a day. New York, New York: Simon and Schuster Inc. Wheeler, M. (2004). Toilet training for individuals with autism and related disorders: A comprehensive guide for parents and teachers. Arlington, TX: World Future Horizons. Wheeler, M. & Kranowitz, C. S. (2007). Toilet training for individuals with autism or other developmental disorders. Arlington, TX: World Future Horizons. Websites Kennedy, B. (2013, July 31). Diaper costs put millions of families in a bind. MSN Money. Retrieved from http://money.msn.com/now/post--diaper-costs-put-millions-of-familiesina-bind www.ds-health.com/train.htm pediatrics.about.com/cs/parentingadvice/a/sp_needs_potty.htm www.dcs-cde.ca.gov/toilettraining.pdf Peer Reviewed Research Articles Azrin, N. H., & Foxx, R. M. (1971). A rapid method of toilet training the institutionalized retarded. Journal of Applied Behavior Analysis, 4, 89-99. doi: 10.1901/jaba.1971.4-89 Brazelton, T. B., Christophersen, E. R., Frauman, A. C., Gorski, P. A., Poole, J. M., Stadtler, A. C., & Wright, C. L. (1999). Instruction, timeliness, and medical influences affecting toilet training. Pediatrics, 103, 1353-1358. Foxx, R. M., & Azrin, N. H. (1973). Dry pants: A rapid method of toilet training children. Behaviour Research and Therapy, 11, 435-442. Friman, P. C., & Vollmer, D. (1995). Successful use of the nocturnal urine alarm for diurnal enuresis. Journal of Applied Behavior Analysis, 28, 89-90 LeBlanc, L. A., Carr, J. E., Crossett, S. E., Bennett, C. M., & Detweiler, D. D. (2005). Intensive outpatient behavioral treatment of primary urinary incontinence of children with autism. Focus on Autism and Other Developmental Disabilities, 20, 98-105. Simon, J. L., & Thompson, R. H. (2006). The effects of undergarment type on the urinary continence of toddlers. Journal of Applied Behavior Analysis, 39, 363-368. Tarbox, R. S. F., Williams, W. L., & Friman, P. C. (2004). Extended diaper wearing: Effects on continence in and out of the diaper. Journal of Applied Behavior Analysis, 37, 97-100. Taubman, B., Blum, N. J., & Nemeth, N. (2003). Stool toileting refusal: A prospective intervention targeting parental behavior. Archives of Pediatrics & Adolescent Medicine, 157, 1193-1196. Vermandel, A., Weyler, J., De Wachter, S., Wyndaele, J. (2008). Toilet training of healthy young toddlers: A randomized trial between a daytime wetting alarm and timed potty training. Journal of Developmental and Behavioral Pediatrics, 29, 191-196. Wu, H. (2010). Achieving urinary continence in children. Nature Reviews Urology, 7, 371-377.
