Abstract
OTs often struggle to target toilet training in interventions, as there is currently no verifiable means to measure progress of the tasks associated with mastering the activities of daily living of toileting and toilet hygiene. This makes the pragmatics of reimbursement and goal writing difficult for many therapists. The purpose of this study is to validate an instrument that measures the developmental progression of toilet-training skills among children with autism spectrum disorder ages two to six years old.
Primary Author and Speaker: Samantha Souza
Additional Authors and Speakers: Lauren Little
Toilet training is a complicated process for many, as there is mixed literature as when to start toilet training, what signs are used to predict readiness, and a lack of verified instruments to measure success in mastering this vital ADL. The process also takes a lot of time, particularly for children with ASD. Some studies suggest that the average amount of time for children with ASD to reach toilet training with urine is 1.6 years; for bowel movement training, the time is 2.1 years (Davlrymple & Ruble, 1992). For many families of children with ASD, the toilet training process can be long and tedious. However, occupational therapists often struggle to target toilet training in interventions, as there is currently no verifiable means to measure progress of the tasks associated with mastering the ADL of toileting and toilet hygiene. This makes the pragmatics of reimbursement and goal writing difficult for many therapists.
The field lacks widely accepted interventions for toilet training children with ASD, largely due to the lack of validated instruments that may characterize 1) the developmental progression of toilet training in ASD; and 2) the unique characteristics that apply to toilet training for children with ASD. Therefore, the purpose of this study is to validate an instrument that measures the developmental progression of toilet training among children with ASD ages 2 to 6 years old.
An online survey of the Potty Training Readiness Questionnaire, a 45 item questionnaire based on a study by Vermandel et al. (2008) as well as clinical reports of toilet training with children with ASD, was posted to open facebook groups for parents of typically developing children and those with ASD. The survey was also distributed to email contacts that exist through our database of parents of children with ASD. Participants were n=141 ASD and n=120 TD ages 2-6 years.
Following data collection, we used exploratory factor analysis (EFA) in SPSS 22.0, which is a method to explain the variation and covariation in a set of variables (Preacher & MacCallum, 2003). Findings showed that 5 factors, as determined by the scree plot, accounted for 55.85% of the variance. After collaboration with our research team, it was determined that the following factors best represented that data: Readiness; Fine Motor, Language, Compliance, and Sensory. Factor loadings ranged from 0.46-.858. Interfactor correlations ranged from -.030 to .750, suggesting unique contributions of each factor. Findings suggest that the Toileting Behavior Questionnaire may be used as a psychometrically sound instrument to assess the development of toileting behaviors in children with ASD.
Research shows that when children are independent in toilet training, they have more opportunities for participation (Richardson, 2016). Parents want their children to attend after school care, summer camps, or dance classes. Their children, however, are often ineligible from such programs that would offer social communication, friendship, or physical and leisure occupation opportunities because they are not toilet trained. Therefore, when we focus on toilet training for young children with developmental conditions, we are not only working on self-care skills. We are opening doors for participation across various contexts that will allow children opportunities to practice skills that have cascading effects on development. This is a critical need we must address to support parents and their children.
Dalrymple, N. J., & Ruble, L. A. (1992). Toilet training and behaviors of people with autism: Parent views. Journal of Autism and Developmental Disorders, 22(2), 265-275. https://doi.org/10.1007/BF01058155
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Preacher, K. J., & MacCallum, R. C. (2003). Repairing Tom Swift’s electric factor analysis machine. Understanding Statistics, 2(1), 13-43. http://dx.doi.org/10.1207/S15328031US0201_02
Vermandel, A., Van Kampen, M., Van Gorp, C., & Wyndaele, J. J. (2008). How to toilet train healthy children? A review of the literature. Neurourology and urodynamics, 27(3), 162-166. https://doi.org/10.1002/nau.20490