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| When Number 2 is Your Number 1 Concern: Solutions for Bowel Movement Training Challenges |
| Saturday, May 27, 2023 |
| 12:00 PM–12:50 PM |
| Convention Center Mile High Ballroom 1E/F |
| Area: AUT/DDA; Domain: Translational |
| Chair: Maeve G. Donnelly (Northeastern University) |
| Discussant: Brandon C. Perez (Northern Illinois University) |
| CE Instructor: Maeve G. Donnelly, Ph.D. |
| Abstract: Most behavior analytic toileting research is dedicated to urinary continence. However, when bowel movement continence is not achieved it can quickly become the number one concern for caregivers due to the impact bowel incontinence can have on an individual’s health and independence. Achieving bowel continence has far-reaching health and social benefits. When concomitant improvements in bowel movements do not occur once urine training is achieved, practitioners need to consider an array of factors related to the assessment and treatment of bowel movements. This symposium will provide an overview of the behavioral literature in this area with recommendations for future research as well as provide practical strategies for the assessment and treatment of bowel movement problems, through an applied study that focuses on treatment strategies for existing toileting habits that delay bowel movement training. |
| Instruction Level: Intermediate |
| Keyword(s): Assessment, Bowel continence, Shaping, Toileting |
| Target Audience: The target audience for this symposium is active practitioners in the field of behavior analysis working with clients who do not display bowel continence. The literature review component of the symposium is designed to identify researched interventions for bowel incontinence to assist practitioners in identifying potential interventions that may be used to resolve bowel incontinence. This paper also includes a call to expand research related to this topic with specific suggestions for both researchers and practitioners. The second paper presents a model for addressing stalled acquisition of bowel training with a specific assessment followed by an intervention based on shaping and fading. Participant data are shared. The discussant has recently (2021) published a paper on this topic in the Journal of Applied Behavior Analysis. |
| Learning Objectives: At the conclusion of this presentation, participants will be able to: 1) List and describe commonly researched bowel movement training components 2) Identify several factors to consider in the assessment and treatment of bowel movement issues 3) Outline a framework for shaping bowel movement routines in the context of toilet training |
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| Let’s Get This Potty Started! A Review of the Bowel Movement Training Literature |
| MAEVE G. DONNELLY (Northeastern University) |
| Abstract: Bowel and urinary continence are associated with nearly universal health and social benefits, and, thus, toileting skills are a common behavioral goal across populations. Review of the literature in this area reveals that most behavior analytic toileting research is dedicated to urine training. Relatively fewer studies have focused on bowel movement training, perhaps due to the frequent use of medical interventions or because concomitant improvements in bowel
movements once urine training is achieved may reduce the need for specific intervention (e.g., Perez et al., 2021). However, absence of healthy bowel movements can result in severe health problems requiring extensive medical intervention. This absence may be due to medical issues, behavioral deficits, or a combination of both medical and behavioral influences. Practitioners seeking to improve bowel movement success in their clients will need to consider an array of
factors in the assessment and treatment of bowel movement problems. This paper presents a summary of the behavioral literature in this area and describes recommendations for future research in the treatment of bowel movement problems. |
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| Individualized Shaping Procedures to Support Bowel Movement Toilet Training |
| (Applied Research) |
| MAIA JACKSON (Summa Academy), Candice Colón (LEARN ), Alison Spanoghe (LEARN Behavioral) |
| Abstract: In some cases, children diagnosed with an Autism Spectrum disorder (ASD) may acquire toileting habits that delay bowel movement toilet training. In addition, some children may also engage in behavior (e.g., aggression) that can interfere with bowel movement training. Due to the social learning impairments associated with ASD, interventions that promote a gradual approach, promote assent and reduce avoidance may be necessary. Previous research has shown that shaping decreases challenging behavior and increases new behavioral habits. However, very few studies have been conducted strictly in the area of BM production and none of these studies have accounted for the child’s strict behavioral routine/habits that contribute to their lack of progress towards bowel movement production on the toilet. This study replicated and extended the literature regarding shaping procedures for toilet training via a multiple probe design. In this study, children who were reliant on an absorbent brief and other specific environmental factors to produce a bowel movement were taught to instead produce bowel movements on the toilet in the absence of challenging behavior. Social validity data reported by caregivers who participated in the study indicated that the training procedure was acceptable and feasible under the direction of the clinical team and able to be maintained by the caregivers thereafter. Interobserver agreement was conducted in at least 30% of all sessions and the mean agreement was 100% for bowel movement production and at least 83% for challenging behavior across all participants. |
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