A pilot investigation of an iOS-based app for toilet training children with autism spectrum disorder

Abstract

We developed an iOS-based app with a transmitter/disposable sensor and corresponding manualized intervention for children with autism spectrum disorder. The app signaled the onset of urination, time-stamped accidents for analysis, reminded parents to reinforce intervals of continence, provided a visual outlet for parents to communicate reinforcement, and afforded opportunity for timely feedback from clinicians. We compared this intervention with an intervention that uses standard behavioral treatment in a pilot randomized controlled trial of 33 children with autism spectrum disorder aged 3-6 years with urinary incontinence. Parents in both groups received initial training and four booster consultations over 3 months. Results support the feasibility of parent-mediated toilet training studies (e.g., 84% retention rate, 92% fidelity of parent-implemented intervention). Parents used the app and related technology with few difficulties or malfunctions. There were no statistically significant group differences for rate of urine accidents, toilet usage, or satisfaction at close of intervention or 3-month follow-up; however, the alarm group trended toward greater rate of skill acquisition with significantly less day-to-day intervention. Further development of alarm and related technology and future comparative studies with a greater number of participants are warranted.

Resolving Barriers to Continence for Children with Disabilities: Steps Toward Evidence-Based Practice

“…For the child, the alarm may increase awareness of the urge to urinate as well as occasion the engagement of muscles that control urine flow (Friman, 2010 ). Modern urine alarm technology includes wireless alerts for both learner and therapist as well as disposable sensors (e.g., Mruzek et al, 2019 ). A urine alarm was used in three studies that met criteria for this review (LeBlanc et al, 2005 ; Lomas Mevers et al, 2018 ; Taylor et al, 1994 ).…”

The Autism Treatment Network: Bringing Best Practices to All Children With Autism

“…Network investigators have studied electronic toilet training alarms, iron supplements for restless sleep, and use of metformin to reduce weight gain associated with use of atypical antipsychotic medications , . 23,24 Three network studies were recognized among the 20 most influential publications of 2017 compiled by the Interagency Autism Coordinating Committee. [25][26][27] One in particular, a randomized, placebo-controlled trial of metformin for the treatment of overweight induced by antipsychotic medication, 27 found that individuals diagnosed with ASD taking atypical antipsychotic medications can use metformin to decrease weight gain from these medications.…”

Parent training for toileting in autism spectrum disorder.

“…Some parents may record data daily. Others may not have the time or wherewithal to do so but can collect data on a more limited schedule, such as 3 days before a consultation visit (Mruzek et al, 2017).…”

“…urine alarms may be particularly helpful when the child shows few obvious indications of the onset of urination, when standard toilet training strategies have yielded limited progress, or when regularly scheduled trips to the toilet are inadvisable (e.g., when the child persistently protests during trips). Most children with ASD tolerate the disposable sensor in their underwear and, with proper training by the clinician, most parents implement the device with their child with little difficulty (Mruzek et al, 2017). When using the alarm, parents should be advised to monitor for new precursor behaviors that may manifest through the repeated pairing of the onset of accidents with the alarm.…”