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THE EFFECTIVENESS OF MODIFIED INTENSIVE TOILET TRAINING METHOD ON THE TEACHING TOILET SKILLS TO CHILDREN WITH AUTISM

THE EFFECTIVENESS OF MODIFIED INTENSIVE TOILET TRAINING METHOD ON THE TEACHING TOILET SKILLS TO CHILDREN WITH AUTISM. Avsar ARDIC, M.A. Atilla CAVKAYTAR, Ph .D Anadolu University , Faculty of Education , Department of Special Education ,

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THE EFFECTIVENESS OF MODIFIED INTENSIVE TOILET TRAINING METHOD ON THE TEACHING TOILET SKILLS TO CHILDREN WITH AUTISM

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  1. THE EFFECTIVENESS OF MODIFIED INTENSIVE TOILET TRAINING METHOD ON THE TEACHING TOILET SKILLS TO CHILDREN WITH AUTISM Avsar ARDIC, M.A. Atilla CAVKAYTAR, Ph.D Anadolu University, Faculty of Education, Department of SpecialEducation, TeacherTraining Program forChildrenwithMentalRetardation TURKEY CEC Convention & Expo Seattle, Washington 2009

  2. Background • First stage of an independence from family, first social environment for individual, is the development of self-care skills. (Bettison, 1982). • Snell and Farlow (1993) indicated that individual begins the independence from parents with developing self-care skills and it is an important for family that children start to accomplish some skills like toileting and dressing. • Ando (1977) noted that “it is much more difficult to toilet train autistic children than even children with profoundly mental retardation, in terms of both effort and length of time required”. • Toileting skills are an important part of person’s development and are a necessary skill that enables independence and acceptance in social settings (McManus, Derby and McLaughlin, 2003). • Individual with developmental disabilities acquires these skills much more late than typically developing children (Bettison, 1982). • .

  3. Literature indicated that toilet skills were learned with definite sequence. Typically developing children learn bowel control first, followed by bladder control, and finally capable of nighttime bladder control (Rubin and Fisher, 1982) • While examining literature, toilet training programs were applied with the a behavioral paradigm which is basis on the principles of operant conditioning and include positive reinforcement and overcorrection procedures (Cicero ve Pfadt, 2002). • This theoretical frame work was applied scientific studies by Azrin and Foxx in 1971. Azrin ve Foxx (1971) called this method a “rapid” method. However, some of following studies were called this method to a “intensive” method and were used like that. • Intensive toilet training method developed by Azrin and Foxx (1971). There are several studies which were modified the different components of the intensive toilet training method and indicated that the intensive toilet training method is effective on teaching toilet skills to children with autism. These studies realized by Luiselli (1996), Cicero and Pfadt (2002), Ricciardi and Luiselli’nin (2003), Post and Kirkpatrick (2004), LeBlanc, Carr, Crossett, Bennett ve Detweiler (2005),

  4. Purpose • The purpose of the study was to determine the effectiveness of modified intensive toilet training method on teaching toilet skills to children with autism. • The following research questions were addressed; • (a) Is modified toilet training method an effective on the teaching urination in-toilet skill to children with autism ? • (b) Is modified toilet training method an effective on the teaching dryness skill to children with autism ?

  5. MethodParticipants • Realization of this research was participated by 3 children with autism. • Participant 1. Chronological age of Erdem is 3 years and 10 months. Participant 1 was diagnosed pervasive developmental disorder by general hospital. Participant 1 was diagnosed autism by Eskisehir Guidance and Research Center. • Participant 2. Chronological age of Mehmet is 4 years and 8 months.Participant 2 was diagnosed psychomotor developmental disabilities and was get committee report by general hospital.Participant 2 was diagnosed autism by Eskisehir Guidance and Research Center. • Participant 3. Chronological age of Sevi is 3 years and 4 months. Participant 3 was evaluated by general hospital. She was diagnosed pervasive developmental disorder-atypic autism and was get committee report by general hospital.Participant 3 was diagnosed autism by Eskisehir Guidance and Research Center.

  6. Participants and Incuding Criteria • The mean of participants’ age is 4.1 years old. Participants got systematic special education between 8 months to one year. None of participants was directly trained by any trainers about toilet skills. • According to Snell and Farlow (1993), there was 3 prerequisiteskills for starting the training of the toilet skills. These are; • First prerequisite skill is that a patterns of the urination has stability. In other words, urination time of participant urinates the certain time of day instead of urinating randomly. • Second prerequisite skill is that participant is dry certain interval in the day, which means that participant keeps pee along at least two or one hours. • Third prerequisite skill concerns with participant’s choronological age.

  7. Design • This study, an experiment, is a single subject design and researcher used multiple probe design across subjects. • Independent variable of this research is that intensive toilet training method, being developed by Azrin and Foxx (1971), was modified by researcher. • This research has two dependent variables. • While participants sat on the chamber pot/toilet, she/he urinate in it,which means that participants was sat on the chamber pot/toilet by researcher and then they urinate in it. (2) Participants do not urinate anywhere,especially urinate in pants, except for chamber pot/toilet.

  8. Data Collection • Baseline and probe level data, intensive training sessions data,inter-observer reliability data, procedural reliability of intensive training sessions data,home applications’ data after intensive training session were collected data record forms which prepared for each type of data. • In this research, baseline , probe and training level data was gathered by researcher. Therefore, researcher was basic data encoder in the gathered all reliabilities data. • Participant parents were collected home training data after intensive training sessions.

  9. Procedure-1 • Using reinforcements in this study was determined by systematic evalution procedure. This procedure included 3 stage. • Training procedure encloses a schedule in which measuring participants’ dryness elapses 30 minutes and after end of this time,application of toilet training elapses 10 minutes. • Each application days was determined/accepted one session which included 8 trials. • A trial enclosed two periods. One of them elapsed 30 minutes in which measured the time of participants’ dryness. After end of this period, it began the time of sitting chamber pot/toilet in which measured the participants’ urination in-toilet and it elapsed 10 minutes. • Intensive toilet training began with which participant have stable data in the baseline level.

  10. Procedure-2 • Participants attended intensive toilet training between 9.00 a.m. to 14.40 p.m.. Intensive toilet training carried on with weekends. Lunch time for participants is between 11.40 to 12.00. In this time, researcher helping participants to eat lunch. • Giving extra-liquidsto participants who wants to drinks but not much than two glasses. • Controlling participants once per 10 minutes for being dry or not being dry during participants is in the classroom for 30 minutes. • If participant is dry, social and food reinforcement was given participant. If not, no reinforcement was given and any punishment procedures was never applied to participant. After said “not dry” to participant, participant’s underclothes were changed by assistant teacher. • Participant attended other educational activities throughout 30 minutes in the classroom.

  11. Procedure-3 • At the end of 30 minutes, participants was carried the toilet by researcher. If necessary, researcher provides physical assistance to participant. • Researcher provides physical assistance for preparing participants and sitting on the chamber pot/toilet. If participant wants to get up the chamber pot/toilet researcher averts his/her. • While participants sit on the chamber pot/toilet researcher allows participant to play a toy which participant chosen in the systematic reinforcement evaluation procedure. • If participant urinates in the chamber pot/toilet, participant takes social and food reinforcement, gets up the chamber pot/toilet before the end of 10 minutes, was carried to the classroom and then researcher allows participant to play a toy which participant wants.

  12. Inter-observer and Procedural Reliability • Independent observers participated in 33,3 % of all sessions and gathered inter-observer reliability’s data. For all participants, inter-observer reliability is 100 % in the baseline and the probe sessions and procedural reliability is 100 % in the training sessions. • According to participants, inter-observer reliability is; • 94,28 % for Mehmet; • 98,95 % for Sevi; • and 99,62 % for Erdem.

  13. Baseline Intervertion Probe Intervertion Probe Intervertion Probe Results-1 Figure 1. Urination in toilet rates of Mehmet, Sevi and Erdem Sessions

  14. Figure 2. Mehmet’s urination intoilet rates in the home applications Sessions Figure 3. Erdem’s urination intoilet rates in the home applications. Sessions

  15. Baseline Intervertion Probe Intervertion Probe Intervertion Probe Figure 4. Urination inpants rates of Mehmet, Sevi and Erdem Şekil 4. Öğrenciler Mehmet, Sevi ve Erdem’in Altını Islatma Oranları

  16. Figure 5. Urination inpants rates of Mehmet in the home applications Figure 6. Urination inpants rates of Erdem in the home application

  17. RESULTS-2 • Graphs in the figure 1 indicates that Mehmet, Sevi ve Erdem never urinated in the toilet during baseline level. During the training sessions, in-toilet urination increased significantly and they urinated in the toilet 100 % of the time, if said sequentially, in the fourth, fifth and third sessions. They sequentially reached the criteria of study in the sixth, seventh and fifth sessions. • Graphs in the figure 2 and 3 show that when examining home applications’ data after intensive training session, Mehmet and Erdem significantly increased in-toilet urination in the home settings and they urinate in the toilet 100 % of the time at the third and second sessions, sequentially. • Graph in the figure 4 indicates that urination in pants rates of Mehmet, Sevi and Erdem are sequentially 66,6 %, 33,3 % and 50 % of the time. This rate of Mehmet decreased 25 % of the time in the fourth sessions, this rate of Sevi decreased 25 % of the time and this rate of Erdem decreased 12,5 % of the time in the third sessions. Mehmet, Sevi and Erdem sequentially reached the criteria of study in the sixth, seventh and fifth sessions. • Graphs in the figure 5 and 6 show that when examining home applications’ data after intensive training session, urination inpants rates of home applications decreased 0 % of the time for Mehmet in the fourth sessions and 33 % of the time for Erdem in the third sessions. • Social validity data indicates that parents were satisfied very much with training and its results.

  18. Discussion-1 • The results of this study manifest that modified toilet training method was effective on teaching dryness and urination in-toilet at acquisition level to children with autism. Examining data gathered from training sessions show that these skills were acquired by participants with autism. • Being parallel to the findings of Azrin and Foxx (1971), the observation of researcher indicates that modified intensive toilet training method can be effective in the bowel control. Therefore, it can be said that another training application is not necessary. • Results expose that this method is effective without overcorrection procedure, which is consistent with the results of Cicero and Pfadt (2002). Lower rates of the urination inpants demonstrates that using the overcorrection is not necessary for decreasing the urination inpants/accidents. • In spite of collecting only two participants data in the home applications, findings may indicate that modified intensive toilet training method is the effective training in the home settings.

  19. Discussion-2 • Necessary time for acquisition of toileting and dryness skills is consistent with the other studies in the literature (Azrin and Foxx, 1971; Cicero and Pfadt, 2002) and it is shorter than the study of Post and Kirkpatrick (2004) which did not include extra-liquids taking. • There were some limitations for this research. First, home applications’ data after intensive toilet training session were collected by parents. Second, in this research, dryness and urination in-toilet skill were teached at acquisition level so results limited information about acquisition level.Finally, one participant’s parent did not collect data in the determined time at the level of home applications. • For future reseach, modified intensive toilet traing method will be tested follow-up studies. In addition,When participants are in the classroom though 30 minutes another research’s purposes can be determined, especially in the fields of the pre-academic or social skills. Home applications will be designed very well for provide support to reseach procedures and findings.

  20. Selected References Azrin, N.H. ve Foxx, R.M. (1971). A rapid method of toilet training the ınstitutionalized retarded. Journal of Applied Behavior Analysis, 2(4), 89-99. Ando, H. (1977). Training autistic children to urinate in the toilet through operant conditioning techniques. Journal of Autism and Childhood Schizophrenia,7, 151-163. Bettison, S. (1982). Toilet training to independence for the handicapped a manual for trainers.USA: Charles C Thomas Publisher. Cicero, F. R., & Pfadt, A. (2002). Investigation of A reinforcementbased toilet training procedure for children with autism. Research in Developmental Disabilities, 23, 319–331. Chung, K. (2007). Modified version of Azrin and Foxx’s rapid toilet training. Journal of Developmental and Physcial Disabilities, 19, 449-455. LeBlanc, L.A., Carr, J.E., Crossett, S.E., Bennett C.M. ve 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. Luiselli, E. (1996). A case study evalution of a transfer-of-stimulus control toilet training procudure for a child with pervasive developmental disorder. Focus On Autism And Other Developmental Disabilities, 11(3), 158-163. McManus, M., Derby, K. M. ve McLaughlin, T.F. (2003). An evaluation of an ın-school and home based toilet training program for a child with fragile X syndrome. International Journal of Special Education,18(1), 73-79. Post, A. R. ve Kirkpatrick, M. A. (2004). Toilet training for a young boy with pervasive developmental disorder. Behavioral Interventions,19, 45–50. Ricciardi, J. N. ve Luiselli (2003). Behavioral intervention to eliminate socially mediated urinary incontinence in a child with autism. Child & Family Behavior Therapy,25(4): 53-63, Rubin, R.R. ve Fisher, J.J. (1982). Your prescholler. New York: Mcmillan Publishing Co. Inc. Snell, M. E. ve Brown, F. (2000). Teaching Basic Self Care Skills”Instruction Of Student with Severe Disabilities. Ed. Snell, M.E. Fourth Edition. New Jersey: Prentice Hall Inc.

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