Evaluating bowel movements, self‐initiations, and problem behavior with the emergence of urinary continence

Abstract

Much of the research evaluating toilet training interventions for children with ASD has focused on urinations as the primary dependent variable. As a result, the effects that toilet training interventions targeting urinations may have on other related dependent variables remains unclear. We conducted a retrospective analysis of data obtained by Perez et al. ( 2020), who evaluated the effects of a treatment package on urinary continence in children with ASD. We examined the relation between the emergence of urinary continence and multiple nontargeted dependent variables: bowel movements, self-initiation correspondence, percentage of appropriate urinations that were self-initiated, self-initiation rate, and problem behavior. Results showed that improvements in urinary continence were strongly correlated with improvements in all nontargeted dependent variables. Implications for future research and clinical practice are discussed.

Health monitoring of students with autism spectrum disorder: Implementation integrity and social validation of a computer‐assisted bowel movement tracking system

“…Practitioners in many service settings for children with ASD and related disabilities may be required to implement bowel elimination training programs (Call et al., 2017; Perez et al., 2021). Recording the occurrence‐nonoccurrence, context, and quality of bowel movements is necessary to evaluate the effectiveness of care provider training and also dietary, pharmacological, and behavioral interventions.…”

“…Specifically, "Data were recorded using paper data sheets by making tally marks in one of two columns ('incontinent' and 'continent') to denote the type of bowel movement" (p. 336). In Perez et al (2021), bowel movements of 13 children with ASD at a treatment center were recorded as a percentage measure from the ratio of appropriate (in-toilet) bowel movements divided by the total number of appropriate bowel movements plus bowel accidents each day. In other programs, bowel movement frequency and percentage data are supplemented with qualitative ratings from scales such as the Bristol Stool Chart (Lewis & Heaton, 1997).…”

“…Further, measurement should be practical, easily implemented, and generalizable among multiple care providers within service settings. Both Call et al (2017) and Perez et al (2021) reported exemplary interobserver agreement (interobserver agreement (IOA)) but did not assess implementation integrity of bowel movement data recording. And although neither study indicated operational difficulties acquiring data, conventional paper-and-pencil forms are easily lost or misplaced and the recorded data must be summarized, centrally located, and displayed for visual inspection (graphs) as separate steps.…”

An Evidence-Based Guide to Toilet Training in the Early Childhood Classroom

“…The purpose of this article is to provide early childhood teachers with an approach to classroom-based toilet training for urination when less intensive toilet training methods are unsuccessful (E1; DEC, 2014). The focus of this article is on urination, but improvements in on-toilet urination may be correlated with an increase in on-toilet defecation (Perez et al, 2021). However, in some cases defecation may require more intensive procedures for continence (Mevers et al, 2020).…”

“…Furthermore, toilet training makes individuals with IDD less vulnerable to abuse (Sapi et al, 2009) and improves their self-image (Collier et al, 2002). Due to the stress associated with the long-term support needs of children who are incontinent (Estes et al, 2009) Toilet Training in the Classroom / Cagliani urination may be correlated with an increase in on-toilet defecation (Perez et al, 2021). However, in some cases defecation may require more intensive procedures for continence (Mevers et al, 2020).…”