Parent training for toileting in autism spectrum disorder.

Abstract

consideration of antecedent events, use of positive reinforcement, shaping behavior, prompting and prompt-fading, functional communication training, and data monitoring. Parents can apply each of these principles to a broad range of instructional goals as their child ages. PREVALEnCE AnD IMPACT Of TOILETIng PROBLEMS In ASDIn the general population of children ages 4 to 17 years, the prevalence rate is 10.5% for incontinence (3.3% daytime only, 1.8% daytime and nighttime, and 5.4% nighttime) and 4.4% for encopresis (Loening-Baucke, 2007). In individuals with ASD, enuresis (i.e., incontinence of urine) and encopresis (i.e., incontinence of feces) are recognized as much more prevalent, although limited epidemiological data are available. In one study of 183 children with ASD, ages 2 to 17 years, approximately 60% had not established daytime urinary continence by 4 years of age (Stanberry-Beal et al., 2014). Although this percentage dropped to about 15% by age 6 years, intellectual disability and lower levels of overall adaptive functioning were associated with enuresis well into the school-age years.negative consequences of urine and bowel incontinence include physical discomfort, compromised hygiene, and decreased privacy. Other threats to quality of life include reduced personal autonomy (e.g., depending on others for help with clothing changes or initiation of bathroom trips), rejection and teasing by peers, and reduced opportunities for inclusion (e.g., acceptance into some day care, general education, and employment settings is dependent on being continent). for students, urine accidents necessitate clothing changes during the school day, disrupting schedules and reducing instructional time. Parents, teaching staff, and other caregivers are burdened with tasks associated with the individual's care, including regularly changing wet or soiled clothing, interrupting family activities (e.g., accidents while at stores or restaurants), and paying for costly diapers and pull-ups (Macias, Roberts, Saylor, & fussell, 2006).WHy DO CHILDREn WITH ASD COMMOnLy HAVE TOILETIng PROBLEMS? four overlapping features of ASD may impede toilet training. Slow Rate of LearningMore than 30% of children with ASD have intellectual disability (Christensen et al., 2016), and many also have expressive and receptive