The Cigna Group · NYSE:CI
The Cigna — Investor Presentation (October 2013)
29 slides from The Cigna's investor presentation, October 2013
Slide 1: Toilet Training your child with Autism
Toilet Training your child with Autism Presented by: Cori Wickett, M.S. BCBA LeafWing Center
Slide 2: Plan for today
Plan for today • Is your child ready? • Are you ready? • Preparing for toilet training • Day-by-day “Potty Party” guidelines • How to handle accidents • Bowel movements • Questions LeafWing Center
Slide 3: Is your child ready?
Is your child ready? • There is no right age • Physical development and readiness skills typically occur between 18 mo and 2.5 yrs LeafWing Center
Slide 4: Is your child ready? Physical signs
Is your child ready? • Physical signs: • Your child can walk • Your child urinates a large amount each time throughout the day • Your child has dry periods of at least 2 hours, or during naps LeafWing Center
Slide 5: Is your child ready? Behavioral signs
Is your child ready? • Behavioral signs: • Can sit in one place for at least 5 minutes • Can imitate your behaviors • Shows some sign when he/she has a BM • Has basic compliance skills • Responds to basic instructions • Puts things where they belong • Understands words for urine and stool LeafWing C
Slide 6: Are you ready?
Are you ready? • Time needed • Emotional energy needed • No big life changes LeafWing Center
Slide 7: Preparing for toilet training
Preparing for toilet training • Buy regular underwear • Buy lots of your child’s favorite drink, and salty foods • Buy a toilet seat that sits on top of the regular toilet seat, and a stool • Prepare potty activities LeafWing Center
Slide 8: Preparing for toilet training cont.
Preparing for toilet training cont. • Teach the words “toilet” and “bathroom” • Make sure there is no aversion to the bathroom or sitting on the toilet • If so, teach tolerance • Take data on your child’s urination schedule (in diaper) • Identify and limit reinforcers for your child • Identify and l
Slide 9: Potty Party - Day 1
Potty Party- Day 1 • Set up potty area • Before your child wakes up • Have potty seat on toilet • Have reinforcers in bathroom but out of reach • Have fun activities in bathroom • Have drinks and salty foods in the bathroom LeafWing Center
Slide 10: Potty Party - Day 1
Potty Party- Day 1 • When your child wakes up, dress them in: • Shirt • If your child does not like being soiled, wear underwear • If your child does not mind being soiled, no underwear • Socks if cold LeafWing Center
Slide 11: Potty Party - Day 1
Potty Party- Day 1 • When your child wakes up, • Allow him/her to drink for 5-10 minutes • Use small bits of salty foods to increase liquid consumption LeafWing Center
Slide 12: Potty Party - Day 1
Potty Party- Day 1 • Toilet time #1!! • Sit your child on the toilet • Underwear pulled down or taken off • Continue to give salty foods and liquids • Keep your child entertained • DVD player • Music • Games/puzzles/coloring LeafWing Center
Slide 13: Potty Party - Day 1
Potty Party- Day 1 • Toilet time #1!! • Stay on the toilet until urination • This could be a long time! • This time is your “baseline” for day 1 LeafWing Center
Slide 14: Potty Party - Day 1
Potty Party- Day 1 • When your child urinates • Lots of verbal praise (make it a “party!”) • Give reinforcer • Allow 10 minutes off the toilet, in or near the bathroom • Continue fluids • If your child has an accident, follow accident guidelines discussed later LeafWing Center
Slide 15: Potty Party - Day 1
Potty Party- Day 1 • Toilet time #2 • Return to the toilet after the 10 minute break • Continue with salty foods and liquids • Keep on toilet until urination, or until the baseline time is up • If no urination when baseline is up, allow a 3 minute break in the bathroom • If your child urinates, REIN
Slide 16: Potty Party - Day 1
Potty Party- Day 1 • Toilet time • Continue until your child has 3 successes, consecutive or not • After 3 successes, decrease fluids and increase time off the toilet by 3-5 minutes with success (staying dry on break and eliminating in toilet) • Continue during the rest of your child’s waking hours
Slide 17: Parent time - Day 1
Parent time- Day 1 • If you can follow all of the guidelines for day 1, be sure to indulge in the reinforcer you have identified for yourself LeafWing Center
Slide 18: Potty Party - Day 2
Potty Party- Day 2 • Restart the procedure as done on Day 1 to get a new “baseline” • Goal for the day: your child should urinate immediately when put on the toilet • Continue with salty foods and liquids • Continue all of your child’s waking hours LeafWing Center
Slide 19: Parent time - Day 2
Parent time- Day 2 • If you can follow all of the guidelines for day 2, be sure to indulge in the reinforcer you have identified for yourself LeafWing Center
Slide 20: Potty Party - Day 3
Potty Party- Day 3 • Restart the procedure as done on day 1 and 2 to get a new “baseline” • This time should decrease each day • Use the “off-potty” time from day 2 for day 3 • Return fluids to normal LeafWing Center
Slide 21: Accidents
Accidents • Remain neutral • Do not make this process aversive, or fun • Help your child (hand-over-hand) clean up the accident with rags • Help your child (hand-over-hand) rinse out his or her clothes • Put your child back on the toilet and add 10 minutes before starting baseline LeafWing Center
Slide 22: Bowel Movements
Bowel Movements • When to start: • Wait to train this skill until well after urination is mastered on the toilet • This skill occurs at a later developmental stage than urination control • Your child should have regular bowel movements each day around the same time LeafWing Center
Slide 23: Bowel Movements
Bowel Movements • Before BM training • To avoid BM accidents, write down the times when your child has a BM each day • Notice signs he may show before having a BM • Attempt to “catch” your child by putting him on the toilet or place him in a diaper • Use a highly preferred reinforcer for going on th
Slide 24: Bowel Movements
Bowel Movements • Starting BM training • Use the same procedures as the urination training, although have your child sit only during the typical “bowel” period • For example, if your child typically goes between 4-6 every day, have him sit on the toilet starting at 3:30 • You may use natural laxativ
Slide 25: Bowel Movements
Bowel Movements • Starting BM training • This process can be scary and difficult for your child • Re-establish a positive routine in the bathroom, playing in or around the bathroom with no demands to use the toilet • Pair a highly preferred reinforcer with success on the toilet LeafWing Center
Slide 26: Bowel Movements
Bowel Movements • Dependence on a diaper for comfort • Reinforce eliminating in the diaper while in the bathroom. • Reinforce eliminating in the diaper while on the toilet. • Cut an increasingly larger hole in the diaper with each success of eliminating on the toilet while wearing the diaper LeafWin
Slide 27: Bowel Movements
Bowel Movements • Remember, this can be a scary and difficult process for your child • Wait at least a few months after urination training to begin bowel movement training LeafWing Center
Slide 28: Summary
Summary • Child readiness skills • Parent readiness • Preparing for toilet training • Day-by-day “Potty Party” guidelines • How to handle accidents • Bowel movements LeafWing Center
Slide 29: Thank You!!
Questions? Thank You!! Cori Wickett, M.S., BCBA cwickett@leafwingcenter.org LeafWing Center
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