An Interview with Sean Barron

By Astrid Liddel

 

Finding someone with high-functioning autism to interview for my blog was surprisingly difficult.  People don’t tend to advertise their autism, so you can imagine how excited I was to have the opportunity to interview Sean Barron about his inspirations and advice to young people with autism—particularly young writers!

Sean is a journalist for The Youngstown Vindicator in Ohio, as well as an author of two well-known books about autism:  There’s a Boy In Here: Emerging from the Bonds of Autism (co-authored with his mother), and Unwritten Rules of Social Relationships:  Decoding Social Mysteries through the Unique Perspectives of Autism (co-authored with Temple Grandin).  He has been publicly speaking at autism conferences about his experiences since 1992.  The following is a transcript of our interview.

 


 

Astrid Liddel:     How has autism affected your life?

 

Sean Barron:     I had a lot of the classic symptoms of autism:  unusual preoccupation with objects, manipulation of objects, very little empathy.  I had a lot of speech and language delays.  Social skills were challenging because I didn’t learn that as a young child.  I had a lot of dietary problems.  I had a lot of sensory overload things, and that impacted my diet.

 

AL:     Has being autistic impacted how you write and speak?

 

SB:     I don’t think it does today. I learned all those things in-depth as I worked my way through my autism. There was a time when autism didn’t impact my life a whole lot. The same is true of my ability to speak in public. By the time I became more proficient at those two skills, I had made tremendous progress in terms of healing. I worked hard to try to connect to the world.

 

AL:     What inspires you to write and speak?

 

SB:     In the early 90s, I made a lot of headway. I have come a long way battling my autism. I started feeling better about myself. I approached my mother about writing a book. Rain Man came out two years earlier, so autism was more known. I decided I wanted to try to write about it and, hopefully, use what I went through as a source of inspiration for people. Mom was reluctant at first; then I convinced her to try it. We wrote the book from our own perspectives, and it came together over time.

 

AL:     What advice do you have for young autistic people?

 

SB:     I really shy away from giving advice, because I don’t feel like I’m an authority on autism. It’s important to not define yourself by a label, because fifty years ago, when I was diagnosed, autism was a terrible thing to have. Now people on the spectrum are given positive things and making an impact. It’s important to strive to do what you feel is purposeful; the things that we all need. People with autism are just as capable as neurotypicals and can have an impact in the world. Think that way as opposed to being defective.

 

AL:     Do you have any specific techniques to manage your autism?

 

SB:     I don’t have any, because it doesn’t impact my life. When I was going through it, I tried a lot of ways. Nowadays I don’t feel like I have to do anything insofar as keeping it under control. I’ve really worked at learning social skills. It is a process, like learning to play a musical instrument or a sport. You work at it and become more proficient at it. They have that in common, in my opinion. The more you dedicate yourself to it, the better you become at it.

 

AL:     Do you have specific advice for aspiring writers?

 

SB:     Writing is also a process. If you want to write, start writing. It doesn’t have to be anything magnificent or a bestseller. Find what your passions are. As far as writing, the first thing is to take notice of what you feel passionate about. If you don’t feel [an] interest, then it will catch up with you sooner or later. Writing is about being able to effectively convey your perspectives of something in a way that other people can relate to and understand. If I’m not interested, I’m not going to write about it. Even if I have a lot of knowledge, if it’s not interesting, the lack of interest will catch up to me.

 

AL:     How have you grown over your career?

 

SB:     I’ve become a better writer. I’ve had people say my writing is distinctive and know I’ve written something without seeing I wrote it. I’ve become more outward-thinking and socially aware; more interested in other people [rather] than in just talking about myself. When I had  [more severe] autism, I was very self-focused because I tried to make sense of the world. Now I feel more in tune with other people. I hate to see people suffer or go through bad experiences. It’s much more about reaching something greater than myself.

 


Astrid Liddel is a CBS staff member and blogger publishing under a pseudonym.

©2018 by Center for Behavioral Sciences, Inc.  All rights reserved.

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Introducing CBS Social Skills Groups for Autism!

We’re excited to announce our newest service for CBS clients:  Social Skills Groups for Autism! 🙌 🎉  Our group sessions are happening now, in our Main Irvine OfficeMastering social skills can profoundly improve life for those with social deficits—particularly in the ability to make and maintain friendships, and to participate in school and the workforce. 

Our social skills groups for autism typically last between two and four hours, and take place by appointment only (depending on staff and client availability) on weekdays between 9:00 a.m. and 6:00 p.m.  Group sessions are a great way to have fun and interact while learning social skills in a supervised, controlled setting.

A functional behavior assessment is usually a prerequisite, to confirm whether the program fits each client’s needs and goals.  So before you begin, please contact us to speak with one of our supervising Board Certified Behavior Analysts to discuss your situation.  Or to learn more about whether this service might be right for you or your loved one, you can also check out our social skills groups for autism page!  


 

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ABA Must Not Overlook Adolescents and Adults

By Shaji Haq, Ph.D., BCBA-D

 

Over the past twenty years, applied behavior analysis (ABA) treatment providers for children with developmental disabilities—particularly autism spectrum disorder (ASD)—have multiplied exponentially.  But ABA treatment facilities for adults are sparse.  This is a tragedy; we’re often stopping short when treatment is still critical, and in some cases, even more so.

Many factors may have contributed to the increase in children’s ABA providers (e.g., Lovaas’ seminal study on the effectiveness of early intensive behavioral intervention in 1987, mandated insurance coverage, and funding and research for ASD treatment), but this increase addresses only part of the issue.  Students with ASD often “age-out” of school systems or ABA agencies, leaving families with limited options—limited in terms of effective treatment, and limited in helping loved ones access services which are critical to independent, adult functioning.

Adult clients may lack the skill to participate in vocational or community integration programs.  For example, adults with ASD who cannot successfully participate in community programs might have severely limited communication skills, difficulty managing personal hygiene, or display severe behavioral inflexibility (e.g., insistence on sameness of routines) that can be barriers to those programs.  Many of these individuals also display problem behavior, such as aggression and self-injury, which often excludes them from participation.

Without ABA services to improve skills and treat behavior problems, the situation may seem bleak.  But it doesn’t have to be.  The key to ABA treatment is always identifying the cause of behavior.  Experimental functional analyses (Iwata et al., 1982/1994), also commonly referred to as Functional Analysis Assessments (FAAs), are the gold standard for identifying the function, or purpose, of problem behavior for individuals (regardless of age) with developmental disabilities.

FAAs are an area of service CBS has begun to provide, which is not commonly found in Southern California.  Our FAAs use rigorous data collection systems and research-based experimental design.  Since 2004, Center for Behavioral Sciences has emphasized teaching individuals of all ages with developmental disabilities to reach greater levels of independence, and our new FAA program is a great step forward.

While an FAA and any behavior intervention translates to vastly different outcomes across individuals, at Center for Behavioral Sciences, we believe that older clients must be recognized as an equally-important population to children with ASD.  Adult treatment goals may range from basic activities of daily living to more advanced skills, such as time management, decision making, how to use public transportation, and vocational training.

If you are interested in finding out about our FAA program, our Intensive Treatment Center or our other services, you can follow the menu above or contact us to learn more!

 

References

Iwata, B. A., Dorsey, M. F., Slifer, K. J., Bauman, K. E., & Richman, G. S. (1994). Toward a functional analysis of self-injury. Journal of Applied Behavior Analysis, 27, 197-209. doi: 10.1901/jaba.1994.27-197 (Reprinted from Analysis and Intervention in Developmental Disabilities, 2, 3-20, 1982).

Lovaas, O. I. (1987). Behavioral treatment and normal educational and intellectual functioning in young children with autism. Journal of Consultation and Clinical Psychology, 55, 3-9. doi: 10.1037/0022-006X.55.1.

 


Disclaimer: This article is for general information only, and is not intended as legal or medical advice.  Individual circumstances and outcomes vary, and the statements in this article may not apply to you. Please contact your health care provider or attorney regarding any specific issue or problem.  The opinions expressed in this post are the opinions of the individual author and may not reflect the opinions of CBS.

©2018 by Center for Behavioral Sciences, Inc.  All rights reserved.

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FINDING BALANCE

Finding Balance:

Autism’s Weaknesses & Strengths

By Astrid Liddel

Autism, depression and anxiety can make life very difficult.  Often, I find it hard just to get out of bed and get dressed.  Not everything is hard for people with autism spectrum disorder (ASD), though.  In this post, I will be discussing some of the things that come (and don’t come) easily and why.

One thing that’s hard for autistic people is maintaining social relationships.  This is because many people with ASD find it hard to read nonverbal social cues, such as facial expressions.  Since people with ASD have difficulty interpreting these silent signals, reading the mood of the room or having conversations may be harder than for neurotypicals.  In addition, people with ASD struggle to properly communicate with their peers. They might repeat phrases they’ve heard or take things literally.  Not everyone who has ASD has these experiences, but for those who do, finding and keeping friends can seem an insurmountable task.

Another thing that makes life hard for people with ASD is sensory issues.  Some people with ASD are hypersensitive to certain stimuli, such as loud noises or uncomfortable food textures.  This means that, in order to cope in high-stimulus environments like parties, people with ASD need to find ways to block out what’s bothering them.  These coping mechanisms can be as simple as using earplugs or weighted blankets.  People with ASD also can be underwhelmed by stimuli and may seek out intense experiences, such as eating spicy food.  Underly-sensitive people with ASD can often have their needs satisfied with appropriate stimuli, such as strong-smelling things or objects to chew on, such as ice cubes.

A third thing that can be challenging for people with ASD is attending school.  School provides challenges in the form of stimuli and socialization.  Getting to class on time or keeping school supplies organized may seem easy to people with neurotypical development, but for people with ASD it is yet another struggle that makes school much harder.  Children with ASD are also often bullied by their peers simply because they are different.  It’s a shame that school—a place where children should feel safe and supported—can be a living hell for people with ASD.

People with ASD do have remarkable strengths, however.  Some things people with ASD are recognized for include attention to detail, honesty, efficiency, high educational qualifications, and visual thinking skills.  These qualities make them potentially excellent employees.  This also proves that many people with ASD can work in stressful social environments and still succeed.  They may need special accommodations, but they are able to work effectively as long as they have their needs met and feel prepared for the undertaking.

One aspect of autism that might be seen as either a weakness or a strength, is the tendency to become obsessed with special interests.  A special interest can be literally anything; all that matters is that it’s a topic the person with ASD will put a lot of focus and thought into.  This means that people with ASD can teach you everything about their special interests, making them able to become experts in any subject they love, whether it’s math, history, science, space travel, or a favorite film series.

Again, these qualities could be excellent in the workplace, and this ability lets those with ASD share their special interests by educating the people around them.  Examples of the many people whose special interests allowed them to thrive in their fields are Barbara McClintock, a scientist, and Bobby Fischer, a renowned chess player.

Autism is often portrayed as a struggle.  While autism does have its challenges, it has many strengths that people don’t often associate with it.  The true struggle is figuring out how to balance weaknesses with strengths.  A person with ASD must decide each day how they are going to deal with their problems, both mental and physical.  They’re not really different from typical folks in this regard—they just see the world in a unique way.  That’s something we should treasure, not overlook.

 

References

Autism Spectrum Australia. (n.d.). Retrieved July 30, 2018, from https://www.autismspectrum.org.au/content/areas-difficulty

Sensory differences. (n.d.). Retrieved July 30, 2018, from https://www.autism.org.uk/sensory

Parents of children on the Autism Spectrum. (n.d.). Retrieved July 30, 2018, from http://www.healthtalk.org/peoples-experiences/autism/parents-children-autism-spectrum/difficulties-education-disliking-school

Autism Spectrum Australia. (1970, January 01). Retrieved July 30, 2018, from https://www.autismspectrum.org.au/content/strengths-and-talents-employers

History’s 30 Most Inspiring People on the Autism Spectrum. (n.d.). Retrieved August 4, 2018, from https://www.appliedbehavioranalysisprograms.com/historys-30-most-inspiring-people-on-the-autism-spectrum/

 


Astrid Liddel is a CBS staff member and blogger publishing under a pseudonym.

©2018 by Center for Behavioral Sciences, Inc.  All rights reserved.

 

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ABA Medi-Cal Funding: An Update

By Ronald Moreno, M.A., BCBA

Background

In 2011, Senate Bill 946 mandated that all health insurers in the State of California provide coverage for Behavioral Health Treatment (BHT) services, such as Applied Behavior Analysis (ABA), for all individuals with an Autism Spectrum Disorder (ASD) diagnosis regardless of age.  ABA was finally recognized as a medically necessary treatment for individuals with ASD!

  In July 2014, the Department of Health Care Services (DHCS) received federal approval to provide BHT services as a Medi-Cal benefit for individuals under the age of 21 with an ASD diagnosis.

Four years later, the Centers for Medicare and Medicaid Services (CMS) came out with a statement that Medi-Cal must cover medically necessary BHT services for all individuals between the ages of 3-21.  That is, if BHT services have been deemed medically necessary, all individuals regardless of diagnosis should be eligible for BHT services if they have Medi-Cal.  These changes took effect less than a week ago, on July 1, 2018.  This is another big win! 



 

How Does This Affect Current ABA Services?

Outcomes vary and health coverage may not be available due to individual circumstances.  And as with any recent change in the law, implementation may be imperfect.  So let’s consider a hypothetical example:

Meet Jane.  She has a non-autism diagnosis (e.g., Intellectual Disability, ADHD, Cerebral Palsy, etc.), is currently receiving ABA services funded by a Regional Center, and also has Medi-Cal benefits.  Under the new rules, Jane will be transitioned to a Medi-Cal managed care plan, such as Inland Empire Health Plan (IEHP), L.A. Care, Molina, CalOptima, Medi-Cal Anthem Blue Cross, or Kaiser Medi-Cal.

However, if Jane does not have a managed care plan, but has what they call “straight” or “fee-for-service” Medi-Cal, Regional Center funding for ABA services continues.  In addition, if Jane only has private insurance, Regional Center funding for ABA services remains.

If Jane currently has an ABA provider, she does not need to do anything to transition funding to her managed care plan. Regional Centers are working behind the scenes with managed care plans to transition services smoothly.  Each Regional Center has its own plan about when to transition services.  Please contact your Regional Center and/or ABA provider for more information about whether and when services will be transitioned. 



 

Starting Service Without Current Regional Center Funding

If you don’t have Regional Center funding for ABA services, here are some steps which might help you get coverage and start service:

  • First, visit a primary care physician, licensed psychologist, or licensed psychiatrist and tell them any current concerns with development, behavior problems, etc.

  • Second, ask a medical doctor or licensed psychologist to prescribe ABA services.

  • After getting that prescription, call the managed care plan and request ABA services.  This can usually be done by calling the member services number on the back of the insurance card.

  • The managed care plan may direct callers to an ABA provider that is in-network or redirect them to the provider directory to research different ABA providers and make a selection.

  • Contact one or more ABA providers.  See if they are currently accepting new clients or if there is a waiting list.  Ask about the program.
  • After finding an ABA provider, they may offer assistance in getting services started.  Be ready to send them a copy of the insurance card, the client’s date of birth, and the prescription for ABA services.  Please make sure you have verified they are a legitimate ABA agency.  You do not want to send your child’s personal information to the wrong person.
  • If an ABA agency intends to provide service, they will likely request a Functional Behavior Assessment (FBA) from your managed care plan prior to the onset of intervention. This is intended to assess the current level of development and observe any reported behavior problems.

If you have other questions and are a CBS client (or are considering our services), please feel free to email BT@centerforbehavioralsciencesinc.com and someone from CBS will be happy to provide you with additional information.

 


Disclaimer: This article is for general information only, and is not intended as legal or medical advice.  Individual circumstances and outcomes vary, and the statements in this article may not apply to you. Please contact your health care provider or attorney regarding any specific issue or problem.  The opinions expressed in this post are the opinions of the individual author and may not reflect the opinions of CBS.
 
©2018 by Center for Behavioral Sciences, Inc.  All rights reserved.

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Making Sense of Autism

Making Sense of Autism:

A Personal Perspective

By Astrid Liddel

My name is Astrid Liddel, and I have autism. You probably have lots of ideas about what I might be like, just by seeing the word ‘autism’ in conjunction with my name. Some of those ideas might have some truth to them, while others might not. So I will tell you about myself so you can see what I am actually like. Hopefully, this will inspire you to see autistic people in a different light.

My autism is probably what you would call ‘high-functioning’. A word of advice about this — some autistic people do not like the ‘high-functioning’ and ‘low-functioning’ classifications, because they feel these labels only lead to discrimination and unfounded assumptions about how autistic people behave. So, even though there are vast differences of functionality on the autistic spectrum, I wouldn’t recommend putting autistic people into categories based on how they behave.

Another thing that might be relevant is that I also have anxiety and depression, which can affect how I function. These additional mental illnesses make it hard for me to simply get up and be productive, so I often struggle to fill my day with activities. I struggle with internet addiction, so as a result a lot of my day winds up being filled by random internet browsing or watching YouTube videos because I am bored. I do go out and volunteer, but at this point my schedule is very empty and very much a work in progress.

In addition, it is difficult for me to read people’s expressions. I know when a cat is angry or hungry because I spend a lot of time around them — I have two cats who provide a lot of emotional support for me — but when I look at people’s faces, they look totally blank to me. I can’t read emotions unless they are extreme, and since most emotions are subtle, that means that most of the time, I have to take wild guesses as to what people are thinking. Imagine being surrounded by faceless robots who you can’t understand, yet you are expected to read like a book. That’s how I feel most of the time.

Social stuff in general is often a total mystery to me. I feel like the only two vocal tones I can recognize are neutral and angry. This makes it often feel like people are upset with me when it turns out that they were not. This also means I have trouble using an appropriate tone of voice when talking to others. I tend to scream when I’m angry, because to me that is the only way that I can convey the intensity of what I am feeling. Because I cannot understand tone or utilize tones properly, this can make me very difficult to communicate with.

I also often take out my anger or frustration on the people around me. This makes it easier for me to end friendships than to start them. Since starting friendships is about as easy as learning a new language, this means I do not have a lot of friends and often spend my time feeling lonely. Lately, it seems that it’s easier for me to have online friends or primarily communicate with real-life friends over text, because then I can monitor what I say and I am less likely to have an outburst and wind up alienating my friends. These online friendships have been incredibly meaningful and supportive, but I often feel pressure to make ‘real’ friends and that something is wrong with me because I don’t have large friend groups like others my age might.

By now, you are probably wondering how to communicate with autistic people in such a way that they can understand you and won’t be intimidated by you. Here is some advice that hopefully will make your relationships with autistic people easier:

    • Above all, treat them like normal people. It’s okay to ask about why they might do certain behaviors, but don’t mock them or tease them, even if you think you are only joking. They might not get your tone and feel upset.
    • Be very straightforward with them. Explain things that might otherwise seem obvious to you. As an autistic person, a lot of subtleties can slip by me and I am sure other autistic people would want everything told to them exactly how it is, even if it means saying something you think they should be able to pick up on without your help.
    • Don’t raise your voice or yell. Some autistic people, including yours truly, are very sensitive to noise, and sudden loud noises can upset or scare them.
    • Don’t assume that they won’t get your sense of humor. Autism and a good sense of humor are not mutually exclusive. That said, if they ask you to explain a joke, please do so.

    These tips are just the beginning of learning to understand and communicate successfully with autistic people. The most important thing you can do is listen, clarify, and be willing to adapt your behavior to make your conversations easier. By following this advice, you will find out in no time that autistic people are so much more than stereotypes make them out to be.

     


    Astrid Liddel is a CBS staff member and blogger publishing under a pseudonym.

    ©2018 by Center for Behavioral Sciences, Inc.  All rights reserved.

     

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CBS, Inc. at the CalABA 36th Annual Western Regional Conference

        

On March 9, 2018, CBS’ Director Dr. Joyce Tu, along with CBS’ Assistant Director Ronald Moreno, Clinical Manager Alex Silva, and behavior consultant Angie Montero presented two original behavior analytic research studies in a poster session, as part of the California Association for Applied Behavior Analysis 36th Annual Western Regional Conference in Santa Clara. The studies are entitled “Teaching Metaphorical Tacts to Individuals Diagnosed with Autism,” and “Teaching Autoclitic Responses to Children Diagnosed with Autism.” CBS is proud of its ongoing contributions to the field of applied behavior analysis, and we are grateful to all study participants.

CalABA is the primary clearinghouse for research and training in behavior analysis in the Western Region of the United States. Dr. Tu is a past president of the CalABA Board of Directors.

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Help Your Child Sleep through the Night Using these Simple ABA Techniques

We’ve posted our tips on tackling toilet troubles. Another common issue for parents and caretakers of children with developmental disabilities is their child’s interrupted or irregular sleep pattern. Below, Dr. Joyce Tu, Ed.D, BCBA-D shares systematic shaping and fading strategies, designed to help regulate your child’s bedtime routine.  Please note that this program is best suited to children with chronic sleeping issues (such as sleeping only 2-4 hours daily for a prolonged period). It is not intended for children who may have experienced only a few sleepless nights.

Before you begin, limit your child’s sugar and caffeine intake before bedtime. Your child should not eat foods that contain sugar or caffeine at least four hours before bedtime.  Implement at least ½ hour of daily exercise in conjunction with this sleeping program.

On the first night, begin with a 12:00 a.m. bedtime. Prompt your child to perform “getting ready for bed” tasks such as brushing her teeth, using the restroom, changing into pajamas, getting into her own bed, and listening to a bedtime story.

Keeping your child awake until 12:00 a.m. might be the most difficult part of the program. Parents who complete this program successfully often report that they engage their children with activities such as taking walks, playing games, etc., to keep the children awake during the first few weeks.  If your child gets up between 12:00 a.m. and 6:00 a.m., prompt her to return to bed with no additional verbal interactions. In other words, do not scold or acknowledge the behavior excessively.

When your child can stay in bed from 12:00 a.m. to 6:00 a.m. for one week:  Move her bedtime to 11:30 p.m. the next night. Then, when she can stay in bed from this time, move bedtime to 11:00 p.m., then to 10:30 p.m., then 9:00 p.m.  Following these procedures, gradually shape your child’s bedtime to suit your household schedule.

 


Disclaimer: The recommendations provided are general. For specific recommendations for you and/or your child please consult with a behavior analyst.
 
©2017 by Center for Behavioral Sciences, Inc.  All rights reserved.

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Toilet Training Made Easy

Introduction

 

Caring for a child, potty accidents come with the territory, especially for those with developmental disabilities such as autism. As common these issues are, the good news is that they are also highly manageable. Our step-by-step guide below aims to tackle even the trickiest of toilet troubles. Let’s dive right in!

The goals here are two-fold.  First, we’ll aim for seven days in a row with no more than one accident.  The long-term goal is for your child to use the toilet for every elimination with no assistance.  This program requires that your child be able to walk, sit for approximately 2-3 minutes, and grasp with her hands.  You will also need the following:

  • Training pants (preferably regular underwear).
  • Simple clothing: no pants/elastic waistband pants, or short shirts for girls.
  • A child-size toilet seat, or child’s potty chair if your child is uncomfortable on the adult toilet. (If you use a potty chair, keep it in the bathroom at all times.)
  • A variety of your child’s favorite drinks.
  • A variety of small food treats that your child likes. (Note: be sure to only make these food treats available as a reward for dry pants! Do not use these treats for anything else.)
  • A variety of your child’s favorite toys and activities.
  • Two or three days of free time with minimal disruption for training.

Understanding the Two Basic Procedures

 

Procedure 1: Toileting

Using the toilet is a chain of many small steps. Your child must be taught each of the following steps to help her learn these habits effectively:

a.  Come up with a signal for your child to use to tell you she needs to go to the toilet:

Ask, “where do you go potty?” and vocally prompt the answer “toilet” or “bathroom.” Have your child imitate “toilet” or “bathroom” aloud if necessary. Praise your child for answering “toilet” or “bathroom.” If your child cannot talk, have her use a gesture or a picture.

b.  Have your child walk to the bathroom in front of you. Physically prompt your child to do so if necessary.

c.  Have your child take down her pants and sit on the toilet.

d.  Give your child 2-3 minutes to use the bathroom. Encourage her to do so by stating “go potty.”

If your child eliminates, praise her and provide food treats (or other reinforcers of their choice). If your child does not eliminate, ignore it. Do not scold or express disappointment. Go to the next step.

e.  Flush the toilet (or empty the portable potty) only if your child eliminates.

f.  Say “Get down” and have your child pull up her pants.

g.  If this was performed during a wet version of the “dry pants check” (Procedure 2 below), have your child walk back to the place she wet herself and change to dry pants

h.  Continue with the toileting schedule.

Procedure 2: Dry Pants Check

This is a way to teach your child that you want her pants to be dry all the time.  The procedure is as follows:

a.  Ask your child “Are you dry?” Help your child place her hand on the crotch area of her pants so that she can feel for wetness.

b.  If your child is dry:

Praise her for being dry (e.g., “Nice dry pants”), and give her lots of social reinforcers (e.g., hugs, kisses). Then give your child a small piece of the food treat or a sip of a drink.

c.  If your child is wet:

Tell her “No wet pants.” Take her immediately to the toilet (using Procedure 1 above). Have your child do as many of the steps as possible and use hand-over-hand prompting for those steps your child does not know.

d.  For the steps your child can partially perform:

*Pair every step in this procedure with the actual instruction (e.g., “walk to the bathroom”).

*Do not talk to or praise your child during this procedure; only give those verbal instructions to complete the step(s) involved. Your voice should be calm but firm.

*Do not scold or reinforce behavior (such as with a drink or affection) during this procedure.

Day One

 

Step 1. Change & Drink:

After a small breakfast (no starches) change your child’s diaper to training pants. At breakfast have your child drink at least 1 ½ cups (6 oz.) of her favorite drink.

Step 2. Perform Procedures 1 & 2:

Five minutes after breakfast perform a dry pants check (Procedure 2).

If your child is dry, praise her and give her a small piece of her food treat. Then ask, “What do you need to do?” Verbally prompt your child to state, “Go potty.” Proceed to performing toileting (Procedure 1). If your child eliminates, give her lots of praise and a reinforcer of her choice. If your child does not eliminate, say “nice try” and continue with the toileting schedule below.

Step 3. Toileting Schedule One:

After performing the above procedures, repeat the following cycles:

a.  Every 10 minutes: Dry pants check (Procedure 2).

b.  Every 20 minutes: Toileting (Procedure 1). Do this approximately 10 minutes before your child has a bowel movement (BM).  The BM schedule is based on what you recorded on the original toileting data sheet prior to training. Record whether your child was dry, wet, and/or had a BM.

c.  Every 1 hour:  Have your child drink a ½ to 1 cup of her favorite drink.

Step 4. Toileting Schedule Two:

When your child is eliminating in the toilet with no accidents for at least three hours:

a.  Every 15 minutes: Dry pants check (Procedure 2).

b.  Every 30 minutes: Toileting (Procedure 1).

c.  Every 90 minutes: Have your child drink a glass of liquid.

If your child has four or more accidents in a row, have your child repeat the toileting procedure after each accident two times and decrease consumption of the drink to a ½ cup.

Final Steps:

For every three-hour interval your child goes without any accidents:

  • Increase the intervals between dry pants checks and toileting procedures by 5 to 10 minutes.
  • Increase the intervals between liquid consumption by 30 minutes.

Diapers should only be worn when your child is asleep.  Eating schedules should be kept the same, but prepare lighter meals with fewer starches.

Day Two and Beyond

 

Continue with the same toileting schedule you ended with on Day 1. When your child is eliminating every two to three hours, stop giving liquids on a scheduled basis and slowly thin out (decrease) reinforcers for eliminating in the toilet.  By continuing to follow this procedure, you and your child will be on the way to success!

 


Adapted from Toilet Training in Less Than a Day by Nathan H. Azrin and Richard M. Foxx

Disclaimer: The recommendations provided are general. For specific recommendations for you and/or your child please consult with a behavior analyst.

©2017 by Center for Behavioral Sciences, Inc.  All rights reserved.

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china Lecture Conference

CBS Helps Bring Behavioral Science to China

Dr. Joyce Tu, Ed.D, BCBA-D, Director of Center for Behavioral Sciences, traveled to China for the second time this year to share the science of behavior analysis. Dr. Tu traveled to four cities in China within Liaoning and Shanxi, serving as a consultant and lecturer on topics in behavior analysis for over 300 special education teachers. These teachers were part of the Chinese Federation for Disabled People, which is supported by the Ai You Foundation. Currently, Ai You has two of the largest children’s healthcare projects of their kind in the world.

Behavior analysis is a burgeoning field overseas. This year’s endeavors are part of CBS’ greater initiative to help implement behavioral analytic practices abroad. In addition to her ongoing work in the United States, Dr. Tu has consulted and lectured for organizations in China, Bahrain, Romania, and India.

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