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Parent-Child Interaction and Autism Spectrum Disorder ASD
Autism continuing education social worker CEUs

Section 3
Parent-Mediated Interventions for Toddlers with Autism

CEU Question 3 | CEU Test | Table of Contents | Autism
Social Worker CEUs, Psychologist CEs, Counselor CEUs, MFT CEUs

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On the last track, we discussed Sleep Issues.  These included Keeping Your Child Awake During the Day, Bedtime Routines, Not Giving In and Dark versus Light.

Have you ever worked with the families of autistic children who are toilet training?  How did you respond? 

On this track, we will discuss Toilet Training.  This will include Seven Steps to Toilet Training.  As you listen to this track, compare the methods offered here with the ones you suggested to stressed-out frustrated parents of autistic children.

Stanley, age 35, and Lynn, age 34, were parents to Landon, age 4, who had autism. Stanley stated, "Landon’s still wetting and soiling himself.  If diapers didn’t exist, I don’t know what we’d do! We can’t take him anywhere without worrying about taking him to the bathroom at regular intervals…and of course, it’s terribly embarrassing to be with friends and worry about your 4-year-old smelling.  At age 4, it seems like it’s high time he went from diapers to underwear!" How might you have responded in Stanley situation? 

I stated, "Children with autism generally get toilet-trained later than typical children, as their parents already have a lot on their plates.  In addition, because of communication difficulties, it may be more difficult for them to understand the process." 

Lynn asked, "That’s just it…how do we help Landon understand the process?  If he’s not going to be communicative when his bladder feels full, we certainly won’t know it for him. How do we help him make a connection?"  I stated, "In the past, I have used a seven-step method with the families of autistic children." 

Using a Toilet-Training Chart
I continued to state, "Before you begin the steps, it can be helpful to have a toilet-training chart.  Create 6 columns with place, date, time, accident, taken to toilet and self-initiation. If an accident occurs, you will want to note what kind, whether urine or bowel.  When Landon is taken to the toilet, you will also want to note if he uses the toilet, and, again, if it is urine, bowel or nothing. With self-initiation, you will want to note if he initiates going to the bathroom only in some cases or in all. Try to pay attention to cues Landon may give you, to indicate when he has to use the bathroom and if he needs to urinate or have a bowel movement." 

Have you found, as I have, that a toilet-training chart can be helpful to parents who are trying to pick up bathroom cues their children are trying to give them?  In your experience, has it helped speed up the toilet-training process?  Stanley stated, "This seems like a lot of work.  What if we don’t have time for this?"  I stated, "It will be a lot of work for a while, but using these seven steps, it can be accomplished in a short period of time with consistency."

7 Steps in Toilet Training
Step #1 - I stated, "First, pick a date, at home, when you can get help, if possible.  The program is a lot of work for the first few days, and some extra hands may be helpful, though not necessary.

Step #2 - Second, on that chosen day, give Landon plenty of liquids all day long.  This will ensure that he will need to urinate and will provide more opportunities for success.

Lynn asked, "I presume that the methods are the same for toilet-training with bowel movements…except we would feed him a lot instead of giving him a lot of liquids, right?"

Step #3 - I stated, "That’s right.  That’s probably the only thing that would change between teaching toilet-training for urinating versus bowel movements.  The third step is to take Landon to the toilet every 20 to 30 minutes.  Make sure he stays on the toilet long enough to relax his muscles. Feel free to read to him or entertain him in some other way while he’s seated.

Step #4 - Four, reward any successes with favorite items.

Step #5 -Five, reward Landon periodically for dry pants. In the beginning, you’ll want to check often. You can check when you take him to the toilet and once or twice in between. Cheer for him and give him a treat, a hug, or anything else he likes if his pants are dry.

Step #6 - Six, if Landon has an accident, you might have him practice walking from the spot where he had the accident to the toilet, and have him sit on the toilet. Try not to punish him or scold him. You can do this matter-of-factly.

Step #7 -Seven, You can continue to take Landon to the toilet regularly, be vigilant, and try not to miss cues. This can be critical in the beginning and until Landon starts initiating. Later, you can prompt him to go on his own."

Stanley and Lynn wanted more information so I continued,  "Once you have decided to toilet-train Landon, make sure you stick to it. It might be effective, for example, not to use diapers anymore, or Landon might try to hold it until you put the diaper on. Some of the families of autistic children I have worked with have reported to me that their children are completely toilet-trained in two to seven days if their caregivers are consistent. 

"After the initial day, you may need to make sure that you or whoever Landon is with takes him to the bathroom at regular intervals, as it may take a while for him to learn to self-initiate. As you said before, many children with autism just don’t make the connection that when their bladders feel full, they need to find a toilet, but by giving them lots of liquids, you can help Landon make the connection and speed up the process."

Do you have a Stanley or a Lynn who are experiencing stress due to having an autistic child they are trying to toilet train?  Do you feel playing this track would be beneficial?  Or, do you have a colleague who might appreciate hearing this track?

On this track, we discussed Toilet Training.  This included Seven Steps to Toilet Training in a Week.

On the next track, we will discuss an article by Dr.’s Stanley Greenspan and Serena Wieder on Meltdowns.  This will include Warning Signs of Meltdowns and Warding Off a Meltdown.

Peer-Reviewed Journal Article References:
Chlebowski, C., Magaña, S., Wright, B., & Brookman-Frazee, L. (2018). Implementing an intervention to address challenging behaviors for autism spectrum disorder in publicly-funded mental health services: Therapist and parent perceptions of delivery with Latinx families. Cultural Diversity and Ethnic Minority Psychology, 24(4), 552–563.

Kasari, C., Gulsrud, A., Paparella, T., Hellemann, G., & Berry, K. (2015). Randomized comparative efficacy study of parent-mediated interventions for toddlers with autism. Journal of Consulting and Clinical Psychology, 83(3), 554–563.

Rispoli, K. M., Mathes, N. E., & Malcolm, A. L. (2019). Characterizing the parent role in school-based interventions for autism: A systematic literature review. School Psychology, 34(4), 444–457

Online Continuing Education QUESTION 3
What are the seven steps to toilet training in a week? To select and enter your answer go to CEU Test.

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