An Evaluation of Urine Alarms in Intensive Toilet Training Programs

Over 50 years of research suggests that toilet training based on behavioral principles is effective for most individuals with intellectual and developmental disabilities (IDD). However, many adults with IDD are never effectively toilet trained. Lack of independent toileting is associated with detrimental physical, mental, and social experiences. Additionally, individuals who are not toilet trained face barriers accessing meaningful educational, recreational, and vocational settings. A number of published toileting protocols include audible, urine-detecting alarms as part of comprehensive, reinforcement-based programs with effective results. However, the independent effects of urine-detecting alarms are unclear. Urine alarms may contribute to toilet training effects through reinforcing or punishing functions, or they may help toilet trainers more promptly respond to accidents. Urine alarms might also be irrelevant when used with other well-established procedures. This dissertation included a systematic review with survival analysis and experimental study to understand urine alarm effects.The systematic review of single-case toilet training research was conducted to determine how quickly study participants with IDD were toilet trained given different instructional procedures. A total of 1,105 published and unpublished records were screened, and 54 studies were coded for details about toilet training procedures used and the number of sessions required to acquire toileting skills. Results indicated toilet training required a large number of sessions overall, with considerable variability. Survival analysis indicated no significant differences in overall number of sessions between participants toilet trained with urine alarms, positive practice, or intensive toilet training alone. However, removal of an outlier study yielded significant results, suggesting positive practice (with or without urine alarms) is associated with fewer intervention sessions for some participants.An alternating treatments design was used to compare the rate of accidents and the rate of in-toilet urinations during three conditions: intensive toilet training (ITT), intensive toilet training with an audible alarm (ITT-A), and intensive toilet training with an inaudible alarm (ITT-I). The toilet training programs were identical except for the use of audible and inaudible alarms. Participants were three young boys (aged 4 to 6 years) with autism. The number of in-toilet urinations and the number of accidents were recorded and converted to an hourly rate.Results showed undifferentiated responding across conditions for all participants, with two of three participants appearing to acquire toileting skills during the comparison phase. Undifferentiated responding may indicate accidents are not a reversible behavior when reinforcement and a dense sitting schedule are used or, alternatively, that urine alarms do not result in meaningful improvements in responding compared to ITT alone. Future researchers should investigate the effects of urine alarms in different toilet training programs, and professionals should focus on implementing ITT procedures with fidelity and making data-based decisions to support toileting training skills for individuals with IDD.

Grantor dc:publisher

University of Kansas

Year dc:date.issued

2023

Author dc:creator

• Vickers Johnson, Jenee

Advisors dc:contributor.advisor

• Smith, Sean J
• Travers, Jason C

• Special education
• adaptive skills
• autism
• behavior analysis
• intellectual disability
• potty training
• toilet training

Statement dc:rights

• Copyright held by the author.

Language dc:language.iso

en

Dc Identifier Other

http://dissertations.umi.com/ku:18960

OAI identifier oai:identifier

oai:kuscholarworks.ku.edu:1808/38872