PS498 Unit 6 Toilet Training Protocol Example

Sits, Crackers and a Calm Walk Back: A PS498 Unit 6 Intervention Protocol

[Student Name]

Purdue University Global

PS498: Bachelor's Capstone in Applied Behavior Analysis

Unit 6 Intervention Protocol

[Instructor Name]

[Date]

The writer, the clinic, the families, the children and every figure are composite and illustrative; the articles cited are real.

Purpose and Approval

This protocol guides toilet training for Amara, five, and Leo, four, at our Omaha autism clinic during clinic hours, 8:30 to 2:30. It follows the core supported by research: scheduled sits, immediate reinforcement for voids and a calm response to accidents, as in the reinforcement-based procedure studied by Cicero and Pfadt (2002), with modest added fluids and parent training as in the outpatient program described by LeBlanc et al. (2005). Our supervising behavior analyst approved this protocol and is the only person who may change it. Both children's pediatricians approved the fluid limits.

Clothing

From the first training day, both children wear cotton underwear and elastic-waist pants at the clinic, so that accidents are noticed quickly and clothing steps are easier. Diapers are worn only for naps and the drive home in the first phase.

Fluids

Each child is offered a drink every thirty minutes. Total added fluid each day stays within the amount each pediatrician approved, recorded on the data sheet. Extra fluids stop for the day if a child seems unwell.

Sit Schedule

Phase 1: Amara sits every thirty minutes, timed for thirty minutes after each drink; Leo sits every twenty-five minutes. Each sit lasts up to three minutes, or until a void. Sits use a child-sized seat and a footstool.

Phase 2 begins after three consecutive clinic days with no more than one accident: sit intervals lengthen by fifteen minutes.

Phase 3 begins after three more such days: sits occur only at set times, after arrival, after snack, before lunch, after lunch and before leaving, while self-initiations are honored at any time.

Reinforcement

A void in the toilet produces immediate, enthusiastic praise and the child's bathroom reinforcer: two crackers and a sticker for Amara, one minute with the musical toy for Leo. These items are kept in the bathroom and used only for toileting. A self-initiation, any request or sign for the bathroom, is honored immediately and praised, whether or not a void follows. Dry checks every thirty minutes produce brief praise and a high five for dry pants.

A self-initiation is honored every time, because asking is the skill we most want to keep.

Accidents

When an accident is noticed, the technician says calmly, "Let's go to the bathroom," and guides the child to sit for one minute. The child is changed without comment, with privacy, and returned to the activity. There are no reprimands, no positive practice and no loss of activities. The accident is recorded.

Teaching the Full Routine

Each child's task analysis guides the remaining steps. The technician uses the least prompt needed for each step and fades prompts across days. Amara's routine includes cleaning with water from her bottle, following her family's practice. Leo does not flush in Phase 1; staff flush after he leaves, and his separate flush desensitization program runs twice a day outside toileting.

Staff and Privacy

Amara's bathroom help always comes from a woman on staff. Sits happen in the one-toilet bathroom, its door left slightly open. Data are recorded outside the bathroom.

Assent

If a child cries, heads for the door or will not sit on three sits in a row, the technician ends the session and contacts the supervisor before the next sit.

Data

Technicians record accidents, voids in the toilet, self-initiations, dry checks and fluids on the tablet, with times. A second technician records independently on at least one day in four.

Home Phase

After a child meets the Phase 2 criterion at the clinic, parents begin the protocol at home in the evenings and on weekends, following training with the capstone student and the supervisor. Leo's family will use a sit every forty-five minutes in the evening; Amara's family will begin with sits after dinner and before bath. Each family has a one-page summary in plain language, and Amara's is also in Somali.

Bowel Movements

Both families report that bowel movements usually happen at home after breakfast. Parents will offer a five-minute sit with a favorite book after breakfast each morning, with the same reinforcer used at the clinic. A bowel movement in the toilet at the clinic earns a larger reinforcer, chosen with each family.

Generalization and Follow-Up

Kroeger and Sorensen-Burnworth (2009) noted that generalization and maintenance are often under-measured in toilet training research. This protocol probes both. Once a child meets Phase 3, a different technician runs one day of sits each week, and Amara's preschool and Leo's grandparents' home each report accidents for one day per week. Follow-up data are collected for two weeks one month after the success criterion is met.

Decision Rules

If accidents have not fallen by half within ten training days, the supervisor reviews the protocol. If a child regresses to baseline levels for three days in a later phase, the child returns to the previous phase. Success means fourteen straight days at the clinic with one accident or fewer each day and a self-initiation every day.

References

Cicero, F. R., & Pfadt, A. (2002). Investigation of a reinforcement-based toilet training procedure for children with autism. Research in Developmental Disabilities, 23(5), 319-331. https://doi.org/10.1016/S0891-4222(02)00136-1

Kroeger, K., & Sorensen-Burnworth, R. (2009). Toilet training individuals with autism and other developmental disabilities: A critical review. Research in Autism Spectrum Disorders, 3(3), 607-618. https://doi.org/10.1016/j.rasd.2009.01.005

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(2), 98-105. https://doi.org/10.1177/10883576050200020601