The Efficiency of the Rapid Training Program for Students

Introduction 

Background 

Children need systematic training to obtain self-regulating toileting skills. However, children with developmental disabilities may need additional structure and reinforcement to enhance their intrinsic motivation. Though they are capable of acquiring skills that ordinary children have, they do so at a much slower pace (Peters et al. 2016). Toilet training is a challenge for all children with developmental disabilities, but those with Autism Spectrum Disorder (ASD) experience unique problems that have not been studied extensively. According to Peters et al. (2016), toilet-training children with developmental disabilities is a commonly studied self-help skill, but few studies have shown success in toilet training children with ASD because they lack replication. 

Furthermore, research studies have also indicated that after children with ASD acquire toilet skills, they may experience challenges generalizing these skills across different settings or shifting stimulus control, for example, urinating only when wearing a diaper. These challenges are caused by the anxiety and fear related to voiding when using the toilet. Cocchiola et al. (2012) asserts that toilet training children with ASD can be challenging due to their inability to meet developmental milestones and symptoms unique to the disorder such as communicating and transitions. Therefore, of these challenges, there is no perfect direction in which toilet skills should be trained. With the increase of ASD diagnoses, there is need for more research on toilet training. 

Research Gap and Problem Statement 

Literature documents the fact that children with autism face several challenges and one of them is the use of the toilet. Furthermore, it is notable that studies significantly describe strategies that could be applied in helping children suffering from ASD to cope with the challenge of using the toilet, graduate guidance, video priming and modelling, schedule sits, reinforcement-based training, and punishment approaches. While previous research has been done on the application of the two methodologies among children with autism, there remains little research on the strategies that can be used to improve the RTT protocol. It is hence necessary to analyze the training method and to identify some of the ways which it can be improved. 

Objective of the Study

The present study aims to establish the challenges that children with ASD face when learning to use the toilet using the RTT protocol. 

Research Questions

The current study seeks to answer three research questions as part of meeting the proposed objectives, which are stated as follows: 

How long do children with autism learn how to use the toilet with RTT training?

What are the challenges that children with autism have with RTT training for toilet use?

What are some improvements that can be made to RTT for children with autism?

Rationale for the Research 

As a pre-school teacher, I have observed that all children with autism face several challenges and one of them is the use of the toilet. One of the techniques that have been applied to help children is the RTT. The training sparked my interest, as it was an approach that was generally used for children with disabilities. While previous research has been done on its application with children with autism, there remains little research on the strategies that can be used to improve the RTT protocol. This sparked interest to analyze the training method and to identify some of the ways, which it can be improved.

Biblical Perspective

The verse in 1 John 1:1 states “That which was from the beginning, which we have heard, which we have seen with our eyes, which we have looked at and hours hands have touched – this we proclaim concerning the Word of life.” The verse shows that John was not making empty statements but was discussing about things that he had evidence to have seen and touched them. As Christians, we are thus expected to show such a form of evidence and this can be done using data and conduct when researching. One can therefore that what they have learned about teaching is truth by simply doing research to collect data and evidence. False prophets can thus be recognized as those that make assertions without any basis of scientific, research or any form of evidence. For the RTT protocol to be used to train students about potty training, it needs to have accurate evidence regarding its effectiveness. The effectiveness will be studied in the research. The RTT protocol ensures that parents take up their time and train their children on how to use the potty or the toilet. This applies to me as a teacher as the verse emphasizes on the need to make use of evidence before teaching anything to my students. 

Literature Review

The ability to use toilets is a self-sufficient element in the life of a child. The knowledge and ability to appropriately use it should be passed at an early age. In her study, Richardson (2016) explored the need to establish the toilet training aspect at an early age. She argued that there are more advantages related to early training as compared to late training. To support these claims, Richardson noted that there were limited differences in the development of autism and healthy children below nine months as the symptoms are manifested above 12 months. She reveals that early training saves the struggle of the parents, caregivers, and teachers when handling this particular group. In addition, she indicated that the training should be carried out in a collective manner where the teachers, caregivers, and parents take active roles in the lives of the children in question. The study found that positive and reinforcement elements played a significant role in the speed of the autism children's learning process.

The speed of learning among autism children depends on the training techniques applied in the exercise. Similar to Richardson, Cicero, and Pfadt (2002) advocated the application of reinforcement tricks. These approaches, the latter scholars found, increased the routine attribute on the participant of the study as the children always looked forward to being rewarded for their actions. They realized that the combination of the reinforcing technique and the graduated guidance and practice trials directly affect the learning curve of the autism children. It further reduced the toilet accidents experienced by the children in the past as their brains became accustomed to the routine of the whole process. The results also indicated that the teachers, parents, and caregivers understood the risks associated with the training process and were prompted to embrace different interventions to further enhance the welfare of the children during the toileting exercise. 

The learning process of the children with autism under eight years differs depending on the conditions that they are subjected to. Peters et al. (2016) note that the learning curve of these children is low, but it can be enhanced through continuous pieces of training and appropriate reminders. The findings of the study indicated that toilet trained children with autism exhibited great control of their bladder even at night as compared to the new ones. The study also noted that the willingness of the parents to toilet train these children are greatly affected by the characteristics exhibited by them. The parents are forced to cope with other character implications, and this minimizes the time and ability to train them continuously. Therefore, regardless of the Autism disorder, the children are trainable, and the parents have the role of commencing and maintaining the entire procedure.

Lack of information on the condition of the child in question affects the ability of the parents to offer the required interventions. According to Li et al. (2018), observable autism signs took up to four years to be fully manifested. The study advocated for early screening to ensure that the conditions of the children are known beforehand to put necessary measures to boost their development. Based on these studies, there is room to improve the learning curve of the children concerning toileting. The collaboration of the parents, teachers, and stakeholders hastens the training process as they positively contribute to the lives of the children in question. Thus, these parties should take up their responsibilities to positively affect the development of this particular group. 

Methodology 

Research Design 

The current study adopts the qualitative approach to researching. The study follows an action research where the training program (RTT) is be studied, the effectiveness noted, and areas for improvement identified. The procedure will involve the participant Sophia, takin water consistently for 8 hours under the supervision of the parent. She will then have to use the toilet after 30-minute intervals and be trained every time they use the toilet. Positive reinforcement could be applied after the child has successfully used the toilet. The effectiveness will be determined based on the time taken to learn how to use the toilet. Improvements that can be made on the study to benefit children with autism will be specifically examined. 

Baseline data for successful voids in the toilet will be collected for three days before commencement of the intervention. Successful voiding is the release of feces or urine while seated on the toilet. The baseline data will be collected across two settings: home and school. The participant will wear diapers during the baseline period, and parents and teachers with be encouraged to stay on their routine. Data will be collected on task analysis phases for toilet routine regarding voiding. These steps comprise pulling pants down, puling underwear down, sitting on the toilet, standing up, puling underwear up, pulling pants up, and washing hands. Washing hands will entail opening the tap, wetting hands, getting soap and rubbing hands, rinsing, closing the tap, and drying hands. These data will be collected during baseline to allow comparison with intervention data. 

Intervention

Several approaches have been used to toilet train children with ASD. These include graduate guidance, video priming and modelling, schedule sits, reinforcement-based training, and punishment approaches. The intervention that will be used in the current study will be Rapid Toilet Training (RRT). Most of the approaches used to toilet train children with ASD have similar characteristics, but limited research has been done of RRT, which is short-term and more intensive. Past research studies have used less intensive approaches that involved toilet training during school hours until the subjects acquired toilet skills. However, using a more rapid approach such RRT reduces the amount of time needed to toilet train (Cocchiola et al. 2012). The saved time could be used for learning other vital skills such as academics. Researchers have suggested that toilet training affects a child’s academic work; therefore, the training period should be minimized as much as possible. Considering that toilet training children with ASD is challenging due to the time and effort needed to teach the skills, RRT will be suitable to the current study because the intervention will only take 3 days. 

Hypothesis

The present study uses the following hypothesis:

The RRT program will increase successful voiding. 

Limitations with the Study

Due to the nature of the study, it involved a limited number of participants. Precisely, the researcher used only one child with autism who has not been trained on how to use the toilet. This will limit the number of participants and could question the validity of the results. Consequently, the findings of the research cannot be generalized for all children with autism. 

Results 

Table 1 shows the baseline data for different activities involved in behavior training, which the research assessed. 

Baseline	Puling pants down	Pulling underwear down	Sitting on the toilet	Standing up	Puling underwear up	Pulling pants up	Washing hands
Day 1	7	5	8	9	6	5	4
Day 2	9	8	7	6	3	7	3
Day 3	8	7	9	8	5	4	5

Table 1 : the baseline data for different behavior training for the RTT protocol before the intervention

As table 1 depicts, the assessment measured the efficacy levels of the RTT training in seven different behavior types, which included pulling down pants and underwear, sitting on the toilet, standing up, pulling the underwear up, pulling pants up, and washing hands. After three days of the intervention, RTT protocol, table 2 shows the exact findings. 

Experimental Results	Puling pants down	Pulling underwear down	Sitting on the toilet	Standing up	Puling underwear up	Pulling pants up	Washing hands
Day 1	5	3	9	6	4	3	5
Day 2	7	6	10	5	3	5	6
Day 3	8	8	9	4	4	5	7

Table 2 : the experimental results following the application of the intervention 

It is important to compare the average frequencies of the baseline data with that of the experimental data to determine the average efficiencies of the RTT training program, which table 3 indicates. 

Pulling Pants Down		Pulling Underwear Down		Sitting on the Toilet		Standing up		Pulling Underwear Up		Pulling Pants Up		Washing Hands
Baseline	Experimental	Baseline	Experimental	Baseline	Experimental	Baseline	Experimental	Baseline	Experimental	Baseline	Experimental	Baseline	Experimental
8	6.67	6.67	5.67	8	9.33	7.67	5	4.67	3.57	5.33	4.33	4	6

Table 3 : the average baseline and experimental frequencies for each of the behavior training using the RTT protocol 

Discussion and Implications 

As the results indicate, the RTT protocol did not yield significant changes in toilet usage behavior in the respondent in all but two of the factors that were being assessed, which are sitting on the toilet and washing hands. This finding comes as a surprise considering the fact that the reviewed studies herald the RTT protocol as one of the most efficient behavior training strategies for toilet usage among children with ASD. This promotes an inquiry into the possible factors that could have impeded the efficiency of the protocol. According to (), different factors, including the time during which interventions are applied, the number of respondents involved in a study, and the personalization of strategies used determine the efficiency of behavior training programs for children with ASD. Based on the finding from literature, two factors could possibly have affected the quality of the findings obtained. For this case, the strategy was applied for only three days, which is why one may plausibly argue that it was not a duration enough to realize the outcomes. Secondly, ASD is a spectrum of disorders, which means that each patient has individual traits, and the efficiency of one program applied to a specific group may not apply to others, including the case of the participant used in this study. The findings, therefore, have implications for research and practice. Researchers and practitioners should strive to use enough samples of participants and to vary methodologies when using behavior-training interventions, such as the RTT. 

References 

Cocchiola, J. M. A., Martino, G. M., Dwyer, L. J., & Demezzo, K. (December 01, 2012). Toilet training children with autism and developmental delays: an effective program for school settings. Behavior Analysis in Practice, 5 , 60-64.

Richardson, D. (2016). Toilet training for children with autism.  Nursing children and young people ,  28 (2). 

Li, C., Zhou, H., Wang, T., Long, S., Du, X., Xu, X., Yan, W., ... Wang, Y. (December 01, 2018). Performance of the Autism Spectrum Rating Scale and Social Responsiveness Scale in Identifying Autism Spectrum Disorder Among Cases of Intellectual Disability.  Neuroscience Bulletin, 34,  6, 972-980.

Cicero, F. R., & Pfadt, A. (January 01, 2002). Investigation of a reinforcement-based toilet training procedure for children with autism.  Research in Developmental Disabilities, 23,  5, 319-331.

Peters, B., Neon's, I., Kuppens, S., & Benning, M. A. (June 01, 2016). Toilet training in children with a functional defecation disorder and concomitant symptoms of autism spectrum disorder.  Research in Autism Spectrum Disorders, 26,  91-98.