Group Parent Education for Toilet Training Children with Autism: Pilot Data

Background: Parents of incontinent children with developmental disabilities report higher personal stress and distress related to the toileting problems presented by their children than parents of toilet trained children (Macias, Roberts, Saylor, Fussell, 2006).  Continence training not only increases quality of life factors for the child, but also increases the quality of life for the parents by reducing stress and subsequently for other family members as corollary recipients of the distress.  Data derived toilet training protocols have been widely developed and successfully implemented with children with autism (see Azrin & Foxx, 1971; Kroeger & Sorensen-Burnworth, 2009).  However, these protocols are often delivered in external settings or if in home settings, with the intervention of clinical specialists (see Cicero & Pfadt, 2002; Kroeger & Sorensen, 2010; LeBlanc, et al., 2005).  Despite the gains in toileting interventions, children with autism are still often delayed in toileting and parents continue to seek services to aid in continence interventions.  It is important to determine if successful clinical procedures are able to be modified and delivered in group parent education trainings to create more access to needed intervention services.

Objectives:  This pilot study aimed to investigate the effectiveness of using an empirically validated parent-delivered toilet training protocol in a parent training format delivered in a group education setting.  That is, a protocol validated to be successful as an in-home training with professional support was modified to be delivered in a group education format for caregivers of children with autism.

Methods: Study participants included the caregivers of 18 children diagnosed with autism spectrum disorder who were incontinent.  Caregivers were divided into two groups to establish a quasi-experimental multiple baseline across participants.  A previously empirically validated toilet training protocol was modified to a group teaching presentation and delivered to study participants.  Baseline data were collected prior to intervention description and intervention.  Contact information to remote support during training was provided and follow-up group meeting sessions offered at one and two month post-education session intervals.  Caregivers were contacted six months post participation in the group education training to determine efficacy of treatment received.  Social validity data were also collected at that time.

Results: Results indicated that group delivered caregiver training may take longer to train children with autism spectrum disorders with more frequent residual post-training issues.  More than half of the participants (67%) attempted training and nearly half (44%) of those who attempted successfully trained their children.  Social validity appeared to be strong.  Additional analyses investigating individual characteristics of the participant children are being conducted, along with qualitative analyses for those who deferred training (did not attempt to train), as well as comparisons of those who did and did not successfully train.

Conclusions: Commensurate with the established literature regarding toilet training for children with autism, parent implemented group training is effective in teaching continence.  However, while effective, there appears to be areas needing continued focus including time to train, attempt to train and remediating residual training issues.