Toilet Training at Vista

What Does it mean to be toilet trained? o Dress and undress with little to no help o Wear underwear day and night o Urine and bowel trained o Fewer than 3 accidents in the last month o Wake up from naps and wakes up overnight dry o Use the bathroom without a schedule or being directed by an adult

Toileting is an Important Personal Skill for our students o It contributes to a person’s self-worth o It affects the ability to achieve optimal social integration in school, recreational, vocational, and familial activities o It is essential to personal independence o Reduced likelihood of potential abuse

Toileting is an important skill for our families o Costly o Stressful o Tiring o Affects who and when others can help care for your child o May limit community access for the family

Toilet training Methods o Timing method o Habit training-schedule trained o Request-based independent toilet training

Timing Method AKA “ the potty dance” Pros

Cons

Based on the student’s overt behavior

Often is too late and accidents will still occur

May connect the internal sensation to the act of voiding

Creates a dependency of the child on the caregiver Does not focus on requesting the bathroom independently Errors are due to caregiver error (we missed the signs)

Habit Training-Schedule Training Pros

Cons

Helps create bladder control

Creates a dependency of the student on the caregiver

Often is the first step in toilet training

Does not focus on requesting the bathroom independently Produces prompt dependency on the schedule and the care givers The behavior that is taught is holding of urine until taken to bathroom Accidents are due to caregiver error (we did not follow schedule)

Request-Based Independent Toileting Pros Increased opportunities for inclusion in LREs Toileting behavior is under the control of the child Easier to implement for care givers Less prompt dependent on caregivers and schedules

Cons

Individualized Program-VTTP Program Components may or may not include: - Use of positive reinforcement - Over-teaching for accidents - Dry pants checks to reinforce dry - Prompted intervals to sit on toilet - Increased fluid intake - Use of liquid sensor

Toileting at Vista: From assessment to Practice Toilet Training Readiness Assessment Inventory (TTRAI) Component Skill Development Individualized Protocol

What is the TTRAI? o Assessment looking at necessary and “nice to have” skills that guides the development of component skill development plans, individualized toilet training programs, and IEP goals o Completed yearly until the student meets the criteria for toilet trained o Guided by the BC’s and completed by staff and parents o This allows us to assess this skill at least yearly to ensure we are always addressing the needs of the student

How Should We Address Toilet Training? • SYSTEMATICALLY – Assess the problem/need

• OFTEN – Every year at IEP time with the TTRAI

• WHOLISTICALLY – Develop programming to target skill development – Consider TT as a constellation of repertoires

How do we achieve optimal success?

Toilet Training starts day 1!

Readiness Indicators Initiating to toilet or bathroom independently Showing discomfort when wet or dirty Taking off diaper when wet or to go to bathroom No longer resisting going into bathroom, sitting on toilet, changing diaper, etc. • Wait 1 ½-2 hours between voids • Sit in chair for 5 minutes • Follows single and multi-step directions • • • •

Component Skill Development Crucial to identify and develop prior to toileting: • Child’s level of participation • Communication skills • Motor skills

Component skill development Participation • Toilet training is a complex chain of behaviors • Independent performance of single or multistep directions • Sitting in designated location

Component skill development Communication • • • • •

Various modalities of communication Traveling to a communicative partner Persistence when making requests Discrimination Requesting help

Component skill development Motor skills • Independent dressing • Drinking from an open cup • Ability to get on or off the toilet

Evaluating data and program effectiveness

SYSTEMATIC RESEARCH HAS LEAD TO SOME INTERESTING FINDINGS

Questions???????????