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Wednesday 22 Oct 2014

For Parents


Below you will find information for parents or family members of individuals with autism. The topics covered below include:

Getting Started

Was your child recently diagnosed with an Autism Spectrum Disorder (ASD)? Well, then you’ve come to the right place. Welcome to the Autism Community!! On this website you will find a plethora of information about autism, treatment, special education, research, news and events. If you ever have a question you cannot find the answer to, feel free to email us directly.

Autism is a neurological disorder with unknown causes. There is evidence to suggest that autism is caused by a combination of genetic and environmental factors, but the details about specific genes or environmental factors are still largely unknown. What we do know, however, is that people with autism are impacted in three core areas: communication, social interactions and restrictive/repetitive behaviors. We also know, through extensive research, that early intervention is vital to the future growth and development of individuals with autism.

It is important to know from the very beginning of your journey that autism is treatable! Individuals with autism may learn differently but they are highly capable of learning. They can be taught to communicate, interact socially and engage in appropriate behaviors. Every person with autism has the potential to succeed, but this success may look different that what you envisioned when your child was born. This journey you’re beginning with your child will take hard work and dedication, but it is all worth it!!

There are a few things you need to do soon after your child is diagnosed. The first is to get involved with a local support group. These groups are great for making connections with other parents of individuals with autism who can help you cope with the diagnosis and locate resources in your community. The second thing to begin working on is accessing services for you child. The initial services to get started with are provided free of charge and these include Early Intervention services provided through the state (children under 3), school-based services (children over 3), and additional state-funded services (Department of Developmental Disabilities; DDD). Other services to look into include Applied Behavior Analysis (ABA) providers, Speech-Language Pathologists (SLP), and Occupational Therapists (OT); these services may be provided through state funding, require private pay or be eligible for payment via your insurance plan.

If your child has not yet received a diagnosis, you can find a qualified doctor in your area by visiting our State-By-State resources page.

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Treatment Options

When it comes to treatment options for individuals with autism, there are a variety of options. These included Applied Behavior Analysis (ABA), Floortime, Medications, Occupational Therapy (OT), Pivotal Response Treatment (PRT), Physical Therapy (PT), Sensory Integration Therapy (SIT), Social Skills Training, Speech and Language Therapy (SLT), TEACCH Method, Dietary Interventions, and Vitamins/Minerals.

Applied Behavior Analysis
The most widely known, researched and used are interventions based on the principles of Applied Behavior Analysis (ABA; developed by Dr. Ivar Lovaas). ABA is basically the science of learning. We use this science to create effective interventions to teach new skills, increase the quality of skills, or to decrease/eliminate unwanted behaviors. Interventions based on the principles of ABA are used to teach socially significant skills and behaviors which can include communication, social skills, academics, self-help, and community skills. In essence, anything you would want to teach can be taught using the principles of ABA. The best thing about interventions based on ABA is that they are systematic and data-driven which makes them highly effective.

When looking for therapists to provide ABA services, it is important to ensure they are highly qualified and/or supervised by someone who is highly qualified. The person supervising your child’s ABA-based program should be a Board Certified Behavior Analyst (BCBA). If they are not certified, they are more than likely not qualified to develop a program for your child. The people working directly with your child under the supervision of a BCBA will typically be college students who are pursuing careers in education, people who hold their bachelor’s degree or master’s degree in education or some other related field. Most programs recommend 20-40 hours per week of intensive intervention.

DIR®/Floortime
Dr. Stanley Greenspan, a child psychiatrist, developed a form of play therapy that uses interactions and relationships to reach children with developmental delays and autism. This method is called the Developmental, Individual-Difference, Relationship-Based model, or “DIR®/Floortime” for short. This intervention method is based on the idea that individuals respond and learn best when they are emotionally engaged.

In this intensive one-on-one intervention, the child’s actions are assumed to be purposeful. It is the parent’s or caregiver’s role to follow the child’s lead and help him develop social interaction and communication skills. The interventionist will spend most of the session (typically 20-30 minutes in duration) down on the floor interacting with the child in an unstructured and spontaneous manner. The adult’s focus is always on what the child is doing and it motivated by and they create communication opportunities based on their preferred toys or activities.

Floortime is not an evidence-based intervention, but research into the efficacy of Floortime is on-going. A randomized, controlled study is underway in Canada to determine the effectiveness of intensive DIR/Floortime treatment for one year and two years.

Medications
There is no medication to “cure” autism. There are medications, however, doctors sometimes prescribe to alleviate some symptoms. Some common symptoms doctors will attempt to treat through medication are behavioral problems, attention disorders, anxiety and depression. Medications most frequently used for children with ASDs include selective serotonin re-uptake inhibitors (SSRIs), neuroleptics, stimulants, mood stabilizers, and anti-psychotics. It is important to work closely with a physician or a psychiatrist so they can monitor the individual’s progress when using these medications.

One very important note we’d like to make here is that medications of any kind should really be the option of last resort. There are many other treatment options which are less invasive and pose much less risk than medications, and many of these treatment options are more effective in the long term. If there are behaviors which are impacting your child’s ability to participate in their home, community or school, you should first consult a behavior analyst to work with you to develop behaviorally-based interventions. Additionally, they will be able to help you collect data on the behavior you’re trying to change which will be important information to track if you do decide to begin any medication. This quantitative information (data on the behavior) is imperative so you know whether or not any intervention (including medication) is having a positive effect.

Occupational Therapy (OT)
Occupational Therapy (OT) is specifically designed to teach skills necessary to be involved in the largest occupation of all: living life itself. For children, the occupation of life includes the skills necessary to participate in play, chores, self-care and schoolwork. Occupational therapist focus most of their work on the sensory perception, motor, neuromuscular and visual skill systems. The specific treatment protocol used depends on the specific needs of the child, and may include the use of swings, trampolines, climbing walls, slides, writing and drawing, brushing, deep pressure and/or joint compressions.

Individual treatment sessions range from 30-60 minutes with the occupational therapist. The OT will typically collaborate with the family and other service providers so the skills being taught and the techniques being used can be reinforced in other settings.

Pivotal Response Treatment (PRT)
Pivotal Response Treatment (PRT) is a naturalistic intervention model derived from the principles of Applied Behavior Analysis. Rather than target individual behaviors one at a time, PRT targets pivotal areas of a child’s development, which includes motivation, responsivity to multiple cues, self-management, and social initiations. By targeting these critical areas, PRT results in widespread, collateral improvements in other social, communicative, and behavioral areas that are not specifically targeted. The underlying motivational strategies of PRT are incorporated throughout intervention as often as possible, and they include child choice, task variation, interspersing maintenance tasks, rewarding attempts, and the use of direct and natural reinforcers. The child has a major role in determining the activities and objects that will be used in the PRT exchange. Directed and intentful attempts at the target behavior are rewarded with a natural reinforcer (i.e. if the child attempts a request for a balloon, the child receives the balloon, not a high-five or other unrelated reinforcer).

PRT is used to teach language, decrease disruptive/self-stimulatory behaviors, and increase social, communication, and academic skills. The two primary pivotal areas of pivotal response therapy involve motivation and self-initiated activities. Three others are self-management, empathy, and the ability to respond to multiple signals, or cues. Play environments are used to teach pivotal skills, such as turn-taking, communication, and language. This training is child-directed: the child makes choices that direct the therapy. Emphasis is also placed upon the role of parents as primary intervention agents. PRT is a scientifically based practice for treating autism. The effectiveness of pivotal response therapies has been proven, but ongoing research of its effects on individuals with autism is being conducted.

Physical Therapy (PT)
Physical Therapy (PT) is used to help improve physical functioning which may include muscle tone, posture, balance and/or coordination. Activities included in therapy sessions may involve providing passive, active, resistive or aerobic exercise as well as specific training in functional or developmental motor skills. Many of the activities used are designed to increase endurance, motor control and motor planning. Depending on the needs and preference of you child, treatment activities may incorporate the use of weights, exercise balls, balance boards, swimming, or breathing exercises.

Individual treatment sessions range from 30-60 minutes with the physical therapist. The PT will typically collaborate with the family and other service providers so the skills being taught and the techniques being used can be reinforced in other settings.

For more information on Physical Therapy and schools for physical therapist, click HERE.

Sensory Integration Therapy (SIT)
The goal of Sensory Integration Therapy is to facilitate the development of the nervous system’s ability to process sensory input in a more typical way. Through integration the brain pulls together sensory messages and forms coherent information upon which to act. SIT uses neurosensory and neuromotor exercises to improve the brain’s ability to repair itself. When successful, it can improve attention, concentration, listening, comprehension, balance, coordination and impulse control in some children.

The evaluation and treatment of basic sensory integrative processes in individuals with autism are usually performed by an occupational and/or physical therapist. A specific program will be planned to provide sensory stimulation to the child, often in conjunction with purposeful muscle activities, to improve how the brain processes and organizes sensory information. The therapy often requires activities that consist of full body movements utilizing different types of equipment. It is believed that SIT does not teach higher-level skills, but enhances the sensory processing abilities thus allowing the child to acquire them.

Social Skills Training
Social skills training can include social skills groups, one-on-one social skills therapy, peer modeling, and video modeling. Social skills training can be implemented by psychologists, counselors, special education teachers, behavior therapist, speech therapists or parents. There are many intervention strategies which may be used to teach specific social skills to children including facilitating games or conversations with peers, role-playing, discussions, games and activities to develop and understanding of teamwork and empathy, social stories, play scripts or video modeling.

As with all interventions, there is not one social skills training intervention which works for all individuals Depending on the person, treatment may need to be conducted initially in a one-on-one setting and then worked on in the generalized context with peers. Some kids may respond better to facilitated interactions and some may respond better to video modeling. No matter what intervention strategy works best, it is important that all individuals with autism receive social skill training specific to their needs. Social skills are undeniably important for future success and definitely something that requires a lot of attention and teaching.

Speech and Language Therapy (SLT)
Speech and language therapy (SLT), provided by a speech and language pathologist (SLP) helps people communicate more effectively both verbally and nonverbally using words or body language. SLPs may help individuals with the actual formation of sounds and words (articluation), using communication systems (AAC), information processing, expressing themselves, pragmatics of language (how to use language), reading body language and facial expressions and/or organizing thinking.

Individual treatment sessions range from 30-60 minutes with the speech and language pathologist. The SLP will typically collaborate with the family and other service providers so the skills being taught and the techniques being used can be reinforced in other settings.

TEACCH Method
TEACCH (Training and Education of Autistic and Related Communication Handicapped Children) is a special education program that is tailored to the child’s individual needs based on general guidelines. It dates back to the 1960′s when doctors Eric Schopler, R.J. Reichler and Ms Margaret Lansing were working with children with autism and constructed a means to gain control of the teaching setup so that independence could be fostered in the children. What makes the TEACCH approach unique is that the focus is on the design of the physical, social and communicating environment. The environment is structured to accommodate the difficulties a child with autism has while training them to perform in acceptable and appropriate ways.

Building on the fact that individuals with autism are often visual learners, TEACCH brings visual clarity to the learning process in order to build receptiveness, understanding, organization and independence. The children work in a highly structured environment which may include physical organization of furniture, clearly delineated activity areas, picture-based schedules and work systems, and instructional clarity.

Dietary Interventions
There are a variety of dietary interventions used to treat individuals with autism. All dietary interventions are used based on the specific recommendations of physicians based on specific criteria. It is imperative you consult with your physician, nutritionist and a behaviorist prior to beginning any dietary intervention to ensure the diet is appropriate for your child and that you are able to measure positive change through data collection.

The most common dietary intervention is the Gluten-Free/Casein-Free (GFCF) diet. With this diet all gluten-containing products (i.e. wheat, oats, barley and rye) and all casein-containing products (i.e. all dairy) are eliminated from the diet. This diet is typically recommended to individuals who have specific allergies, intolerances or sensitivities to these proteins. Other diets include the Feingold diet (to treat hyperactivity), the Ketogenic diet (for seizures), the Body Ecology diet, the Anti-yeast/Fungal diet, and the Specific Carbohydrate diet. Remember, it is vital to consult a physician, nutritionist and a behavior analyst prior to beginning any dietary intervention.

Vitamins/Minerals
Individuals with autism may have specific vitamin or mineral deficiencies cause by limited dietary intake or metabolic disorders. It is important, just like with dietary changes, to consult with your physician, nutritionist and a behaviorist prior to beginning any supplement intervention to ensure the specific vitamins and minerals being given are appropriate for your child and that you are able to measure positive change through data collection.

Vitamin deficiencies can cause or exacerbate widespread medical and neurological problems. Thus, it is important that in treating children with autism we replace what they are missing nutritionally. This is just common sense. The trouble is that it’s difficult to determine how much of each vitamin or mineral supplement should be administered. Dosing should be done under the direction of a physician specializing in the treatment of autism, or a nutritionist working in conjunction with other experts who are treating the whole child.

The following are some important nutrients and vitamins which individuals with autism may need supplemented:

  • Vitamin A (Activates the immune system, supports immune memory, protects against viruses, and is critical for vision, sensory perception, paying attention, and language processing.)
  • Vitamin B1 (Plays an important role in carbohydrate metabolism, antioxidation, and biosynthesis of nucleic acids and neurotransmitters.)
  • Vitamin B2 (Necessary for the building of healthy DNA.)
  • Vitamin B3 (May have positive effects on cerebral blood flow.)
  • Vitamin B6 (Some individuals with autism with excitotoxic damage to brain cells may have a vitamin B6 deficiency.)
  • Vitamin B12 (Deficiencies can cause problems with mental functioning including confusion, slow thinking, forgetfulness, and even psychotic episodes.)
  • Vitamin C (Numerous physical problems develop with a deficiency, including weakness, pain, swelling, rash, fatigue, bruising, and gum disease.)
  • Vitamin D (Helps transport calcium to the cells, among other benefits.)
  • Vitamin E (An important antioxidant that scavenges free radicals.)
  • Folic Acid (Deficiency has been associated with numerous neurological problems.)
  • Vitamin K (Helps regulate blood coagulation.)
  • Zinc (Important for brain development and supports the immune system.)
  • Magnesium (Deficiency can decrease blood flow to the brain and cause symptoms like sound sensitivity.)
  • Calcium (Helps build teeth and bones.)
  • Selenium (Important for immune function and critical for pancreatic function.)
  • Molybdenum (Supplementing can help decrease urinary wasting of important proteins.)
  • Omega Fatty Acids (Linked to many facets of neurological health.)
  • Essential Amino Acids (Some individuals with autism on specialized diets may be lacking in these important nutrients.)

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Accessing Services

The Individuals with Disabilities Education Act (IDEA), is the federal law which mandates each state provide all eligible children with a public education that meets their individual needs. This law entitles children with disabilities (including autism) to Early Intervention services (ages 0-2) and Special Education Services (ages 3-21) which are Free and Appropriate (FAPE; Free and Appropriate Public Education). As a parent, it is important to understand that you are an equal partner in the the decision-making when it comes to your child’s education services. Continue to educate yourself and advocate for your child.

To access services in your area, contact your local Early Intervention Agency, if your child is under 3, or your local school district, if your child is over 3. Before services begin, your child will need to be evaluated by the agency specialists and an IFSP (Individualized Family Service Play) or IEP (Individualized Education Plan) will need to be written which specifies the services your child will receive based on their needs.

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School Issues: Individualized Education Plans (IEP)

After your child has undergone a school-based evaluation and the qualifying areas have been determined, and you have accepted the recommendations, the IEP writing process begins. An IEP needs to be written and agreed upon within 30 days of the student qualifying for services. The writing of the IEP is a collaborative effort – all members of the IEP team have a say regarding what goals and objectives will be included in the IEP. These goals and objectives need to be measurable! It is important for the family to understand that each of the goals included in the IEP need to have a unit of measure that can show progress. For example a goal that says “The student will be able to add and subtract” is not a measurable goal. Conversely, a goal that says “The student will add and subtract single digit equations with 90% accuracy (i.e. 9 out of 10 correct) 3 days in a row” is a measurable goal.

Okay, so now that the student has an IEP which includes goals and objectives (which are measurable) based on their areas of need, the next concern is monitoring progress. The student’s progress on goals and objectives needs to be provided to the families at least as often as they receive report cards from their general education teachers (usually quarterly). Progress reports can be sent more frequently if the teacher or the parents wish to do so, but it is only required quarterly. In this way, the families can know how well their child is progressing and if they are on track to meet their goals and objectives by the IEP review date (IEP review dates are discussed below).

Once a year (or more if needed) a student’s IEP is reviewed. During this review process goals can be added, taken out, or modified. It is important that everyone on the team is present and participates in this process. The changes should not come only from the service providers! Parents, related service providers, and the general education teacher(s) have vital import when it comes to the IEP development process.

Every 3 years (or more if needed) a student is reevaluated to determine whether or not they are still eligible for services, and if their areas of need have changed in any way. This is an important part of the process because if your child no longer needs special education services, the services should be terminated, or if their needs have changed those needs should be reflected in the IEP (and changes in services areas can only be modified with a formal evaluation).

Additional IEP Resources for Parents
US Department of Education IEP Guide: This guide was written prior to the 2004 changes to IDEA, but all the information is still useful and relevant for parents.

Kids Together IEP Tips: This website has a lot of great tips for parents to help them prepare for IEP meetings so they can advocate most effectively for their children.

10 Mistakes Parents Make: This article has some great tips for parents to help them get the most out of the special education services available to their children.

IEP and Inclusion Tips: This comprehensive IEP manual for parents and teachers covers topics such as preparing for IEP meetings, developing the IEP, ensuring access to the general education curriculum, tracking and monitoring progress, fostering peer relationships, handling disagreements between IEP team members, and tips for effective collaboration.

Itinerant Connection: This website has some good information about IEP goals, guiding questions to help each team member prepare for the IEP meeting, and information about the role of the general education teacher.

National Parent Technical Assistance Center: This website has many resources available related to special education services.

Parents as Partners in the IEP Process: This comprehensive, parent-friendly manual was written by the Utah Parent Center, but the information is relevant for parents across the country.

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Disruptive Behaviors

All behaviors serve a function, it’s the form those behaviors take that are sometimes objectionable. It is useless to try to address a behavior without first understanding its function because any “interventions” we try will not be maximally effective.

The way in which we can address this is by doing a functional behavior analysis or assessment (FBA). By conducting this assessment we can determine whether a behavior is serving to access or avoid tangibles, demands, attention, or sensory input. Once we know the function of a behavior, it can be effectively addressed.

Too many times children with autism are treated as if their behaviors (i.e. screaming, bolting, hitting, biting, rocking, ignoring, etc.) are symptoms of the child being naughty or misbehaved or not disciplined. They are put in time out, seclusion rooms, ignored, physically prompted, have things taken away, or are given things without really considering whether or not these “consequences” for their behaviors will effectively decrease the unwanted behavior and increase the desired behavior.

Conducting a functional behavior analysis or assessment should be done by someone who understands the forms and functions of behaviors and which interventions are most effective in addressing specific behaviors. Additionally, it is important that any interventions implemented are well planned and followed as consistently as possible to be the most effective. It is not possible for an intervention to be implemented in one environment and not in another and still have the most long-lasting effect. Most importantly, the changes in behavior due to the intervention should be tracked by quantitative data to prove it is effective.

The last note about interventions to address behaviors is that it is not enough to try to eliminate a behavior, because the function of the behavior still needs to be served. For instance, if a child is exhibiting a behavior to gain attention but the form of the behavior is unacceptable…they need to be taught acceptable ways of gaining attention (these are call replacement behaviors). If the child is not taught appropriate means to get their needs met, we are not doing all we can to help them grow and learn. After all, that is the point of teaching and the reason why we teach…not to eliminate unwanted behaviors, but to help children learn and grow and be accepted and loved for who they are.

Behavior Data Collection (ABC Data)

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Quality of Life: Sleeping

A common concern for parents of children with autism is that their child is unable to get to sleep or stay asleep for a full nights sleep. This can be very difficult for a family because it affects every other member of the family and their schedules. The following are suggestions I’ve given to families to help them and their child find success at bedtime:

Establish a predictable bedtime routine. Make sure that the child knows what it coming up by providing them with a schedule of what is going to happen. For example: (1) Bath; (2) Pajamas; (3) Story; (4) Bedtime. A 5 minute warning should be given, then a 1 minute warning, then the bedtime routine should begin. This routine should be the same every night so it is predictable.

All stimulating activities should end at least an hour before the bedtime routine starts. This means that the TV and games should go away. This is a great time for some relationship building activities and possibly some deep pressure activities (i.e. arm/leg squeezes, massages). These should be very calm activities to help the child to prepare for relaxing and bedtime.

Many people have found success using a combination of melatonin and GABA supplements a half an hour to an hour before bedtime. These are natural supplements which are both neurochemicals that induce sleep and help the child stay asleep. Melatonin is metabolized into serotonin which many think may be imbalanced in people with autism.

A white noise machine has been successful for many families. White noise can be useful because it helps drown out all other noise and sensory information. For people with sensory processing differences it can be hard to filter out extraneous information, and white noise CDs and machines can help by drowning out all other sounds so the person can focus on one set of sounds.

When it is time for the child to actually go to sleep, they should be kissed good night and left in their rooms. If they get out of bed, they should be told one time that it’s time for bed and placed back in bed. If they continue to get out of bed again, there should be no more talking, interaction or eye contact; they should be walked back to their bed and calmly placed in bed. If this is the first time establishing the bedtime routine it may take a LONG time for the child to finally get to sleep and many times there will be an extinction burst (more behaviors and more intense) which is the child’s attempt to get their routine back. It is important to stick to it, because it will pay off in the long run.

It is important to remember that routine is key. Calming activities are important. And sometimes supplements are necessary to help regulate the bodies sleep chemicals. The most important thing to remember is to not give up. Your child will thank you and you will thank yourself in the long run.

Sleep Patterns Data

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Quality of Life: Eating

One of the issues many parents face with their children with autism is eating problems. Eating problems come in two main forms: the child does not eat a large variety of foods or they are unable to sit at the table to eat meals. If your child is experiencing one or both of these problems, know that you’re not alone and there are possible solutions to help your child get the nutrition their body needs and participate in mealtime routines.

Food Selectivity and Refusal
The origins of food selectivity and refusal are not always known. There could be a medical issue (i.e. acid reflux, allergies), sensory issues (i.e. preference for color or texture) or some other reason. No matter the cause, food selectivity and refusal needs to be addressed because it typically means the child is not getting the nutrients they need for proper growth and development.

The first step, prior to implementing a feeding intervention, is to collect data regarding the foods your child is eating and get your child evaluated by a medical professional to rule out any medical issues which may be impacting food consumption. These two components are very important before attempting any sort of intervention. When collecting data it is important to record food consumption information for an entire week so you can get a full picture of what your child is eating. Every day write down everything your child eats (record amounts too) including meals, snacks, treats, etc., and everything your child drinks (record amounts too) including milk, juice, water, etc. At the end of the week you should have a lot of information about the amount, type and variety of food your child is consuming. As long as you have worked with your doctor to rule out or take into consideration medical issues, you can move on to the next step.

The second step is to identify, based on the data you collected, patterns of excessive or limited food consumption. For instance, you may notice that most of the food your child eats are sugary foods, grains and dairy with limited consumption of vegetables, fruit and protein. Based on the patterns you find, you can identify the types of foods you need to begin introducing.

The final step is to begin your intervention program of systematically introducing new foods. At this point you may need to consult with a feeding or behavioral specialist to develop a systematic intervention plan. Some kids will take to new foods more easily, but for others the introduction of new foods may elicit disruptive behaviors. Teaching kids to eat new foods will take the use of behavioral techniques with an emphasis on positive reinforcement, so collaboration with a trained professional is highly recommended.

Food consumption data sheet

Mealtime Routine Participation
Difficulties with mealtime routine participation usually includes children not sitting at the table at all or not being able to sit for the entirety of the mealtime. This skill is more of a social goal because mealtime participation is a social skill. While families may not think of this skill as being a top priority, it is a socially important skill which will impact the child’s ability to participate with typically developing peers and in the community. If an individual with autism is unable to sit at the snack or lunch table with peers or go to a restaurant with their family, they are missing out on many potential social interactions and opportunities.

Prior to beginning an intervention to teach this skill, you will need to collect data. It will be be important to determine the following information: How long are they able to sit at the table before leaving? What behaviors do they engage in to escape the table? Are there specific mealtimes for which they sit longer? Is there a pattern of food items present which increases the amount of time they will sit at the table? You should collect data on the mealtime escape behavior for at least a week so you are able to identify patterns of behavior. After you’ve collected the data it will be important to collaborate with a behavioral specialist to help you develop an intervention plan which will be most effective in addressing your child’s specific difficulties.

Behavior Data Collection (ABC Data)

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Quality of Life: Toilet Training

Toilet training can be one of the biggest challenges for parents of young children with autism. This is based more on perception than actual fact. Because the perception is that toilet training is going to be difficult, the propensity is to put it off as long as possible. Unfortunately, putting off the inevitable can actually make toilet training more difficult in the long run, so it is best to get ready and jump in with both feet. Your child will thank you and you will thank your self!

The first step is to assess whether you and your child are ready for training. Some things to look for in terms of your child’s readiness are age (starting potty training by age 3 is most common), waking up dry from naps, awareness of when wet or dirty, and/or interest in the bathroom. In terms of your readiness to begin training, you will need a few days to a week that you are able to dedicate to the potty training process and stay close to home. Do not worry if your child is 3 but not showing any of the other readiness signs. If they’re over 3 and you’re ready, it’s best to start training as soon as you can.

There are a few methods out there to get you started with potty training. Just like every intervention there is no one size fits all method for potty training, but there are few key tips and considerations for all potty training endeavors.

  • Get your materials ready – Some necessary materials include a potty seat (a “little potty” is not recommended), a stool for them to put their feet on, underwear (ditch the diapers… including pull-ups), cleaning supplies for obvious reasons, TV tray for in front of the toilet on which you can place toys and snacks during long sitting sessions, lots of liquids to promote the need to go, a timer so you can take them to the potty regularly, and lots of reinforcers (extra special items your child has limited access to).
  • Reinforce successes – It may not seem like it, but going to the bathroom on the toilet is a difficult skill. There is a lot involved in the process and for a child with autism it may seem like the most difficult thing to do. Just as with any difficult skill, we need to make sure that the reinforcement we’re using to reward success is powerful. What this means for you as a parent is you need to find something your child does not get often, but would do just about anything for. When your child has a success (i.e. pees or poops on the toilet) reinforce them immediately!!
  • Do not punish accidents – Accidents happen! The best way to respond is to simply deal with the mess without giving any emotional or verbal reaction to your child. The last thing you want to do is create anxiety around going to the bathroom, so it’s best to just clean up and move on.
  • Train on the regular toilet – For many kids with autism, trying to train them on the “little potty” could backfire in the long run. This is because the child might get stuck in the routine of going on the little potty and need to be re-trained to go on the big potty. There are plenty of comfortable potty seats to place on the regular toilet to make sitting more comfy. With the addition of a stool on which they can place their feet, you should be set to go.
  • Be patient – Toilet training can take time, so you need to be patient. Make sure that you begin toilet training only when you’re ready and you have the time and resources to dedicate to this endeavor. It could take two days or two weeks, but please know that it will happen. If you’ve tried and you’re still not having success, it may be time to consult with your behavioral specialist to evaluate the situation and help you come up with a plan for success.

Toilet Training Data

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Resources:
1. First 100 Days Kit – Autism Speaks

Trackbacks

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  3. [...] Response Treatment (PRT) is an intervention based on the science of Applied Behavior Analysis (ABA). PRT is considered a [...]

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