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Paquet Croteau N, Moore C, Griffith A, Franco E. The Effects of a Caregiver Implemented Toilet Training Package. J Autism Dev Disord 2023; 53:4185-4198. [PMID: 35972624 DOI: 10.1007/s10803-022-05703-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/25/2022] [Indexed: 10/15/2022]
Abstract
Toileting skills are a milestone typically achieved by the age of four. For many caregivers, particularly those who have children diagnosed with autism spectrum disorder or other developmental disabilities, teaching toileting is a challenge resulting in delayed implementation. Delaying toileting increases the risk of challenges to acquiring this skill. Caregivers are fundamental and research shows that their involvement supports the maintenance and sustainability of this skill. Four caregivers were taught a 24-step toilet training program to teach toileting. Behaviors measured included urination success, urine accident frequency, and child requests for the bathroom. All caregivers learned the 24-step procedure and the toilet training package was effective in teaching three of the four children daytime urine continence.
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Affiliation(s)
| | - Colleen Moore
- The Chicago School of Professional Psychology, Chicago, USA
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Eke H, Hunt H, Ball S, Rogers M, Whear R, Allinson A, Melluish J, Lindsay C, Richardson D, Rogers J, Hutton E, Madden N, Wright A, Anderson R, Logan S, Thompson Coon J, Morris C. Improving continence in children and young people with neurodisability: a systematic review and survey. Health Technol Assess 2021; 25:1-258. [PMID: 34866570 DOI: 10.3310/hta25730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Children and young people with neurodisability often need help to achieve socially acceptable bladder and bowel control. Approaches vary depending on whether or not the impairment results from spinal cord pathology that impairs motor control and sensation of the bladder and bowel. Currently, there is uncertainty about which interventions are effective. OBJECTIVE The objective was to summarise the available evidence on and current practice for improving continence in children and young people with neurodisability. DESIGN A systematic review of the effectiveness, cost-effectiveness and factors that modify intervention implementation, alongside a cross-sectional, online survey of current practice with health professionals, parent carers, school and care staff and young people with neurodisability. RESULTS Twelve databases were searched in the review, resulting in 5756 references; 71 studies (72 papers) were included in the analyses. Most of the evidence was for children with spinal cord pathology, which involved evaluations of pharmacological approaches and surgical techniques, whereas the evidence pertaining to those with non-spinal-cord-related pathology tended to be for behavioural interventions. The methodological quality of studies was rated as being moderate to poor. There were three robust qualitative studies about the experience of continence among children with spinal cord pathology. We found substantial heterogeneity across the interventions that we evaluated in terms of quality, study design and outcomes measured. No economic studies were found. The results were synthesised narratively and reported in text and tables. We did not find any eligible studies evaluating interventions using toilet and clothing adaptations in the review, although the survey highlighted that these types of interventions are frequently used and considered. In total, 949 people responded to the survey: 202 health professionals, 605 parent carers, 122 school and social care staff, and 20 young people. The survey results illustrated the different roles that professionals have in improving continence, highlighting the importance of a multidisciplinary approach to supporting children and young people and their families. Clinicians employ a range of assessments and interventions to improve continence or independent toileting, depending on the needs of the child. LIMITATIONS Quantitative studies in the review were not methodologically robust. The survey had a risk of response bias. CONCLUSIONS Our research found a dearth of good-quality evidence for many of the interventions currently in use, and no evidence of experiences of implementing interventions for children with non-spinal-cord-related pathology. There was also no evidence of cost-effectiveness of any of the interventions. FUTURE WORK There is a need to involve young people and families in the design of high-quality evaluative research for interventions that aim to improve continence. This is especially the case for children with autism and learning disability, who have been neglected in previous evaluative and qualitative research. We recommend better training for health, education and care professionals about toileting, informed by evidence and the lived experiences of children and their families. We recommend a joined-up multidisciplinary and holistic approach to improving continence to maximise independence, dignity and comfort. It is vital that children and young people with neurodisability have early access to regular, integrated assessment of their bladder and bowel health, and are fully supported with appropriate personalised treatment. STUDY REGISTRATION This study is registered as PROSPERO CRD42018100572. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 73. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Helen Eke
- Peninsula Childhood Disability Research Unit (PenCRU), University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Harriet Hunt
- Evidence Synthesis & Modelling for Health Improvement (ESMI), University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Susan Ball
- Health Statistics Group, University of Exeter Medical School, University of Exeter, Exeter, UK.,National Institute for Health Research (NIHR) Applied Research Collaboration (ARC) South West Peninsula (PenARC), Exeter, UK
| | - Morwenna Rogers
- Evidence Synthesis & Modelling for Health Improvement (ESMI), University of Exeter Medical School, University of Exeter, Exeter, UK.,National Institute for Health Research (NIHR) Applied Research Collaboration (ARC) South West Peninsula (PenARC), Exeter, UK
| | - Rebecca Whear
- Evidence Synthesis & Modelling for Health Improvement (ESMI), University of Exeter Medical School, University of Exeter, Exeter, UK.,National Institute for Health Research (NIHR) Applied Research Collaboration (ARC) South West Peninsula (PenARC), Exeter, UK
| | - Annette Allinson
- Peninsula Childhood Disability Research Unit (PenCRU), University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Julia Melluish
- Peninsula Childhood Disability Research Unit (PenCRU), University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Claire Lindsay
- Paediatric Bladder and Bowel Care Team, Northern Devon Healthcare NHS Trust, Exeter, UK
| | | | - June Rogers
- Bladder & Bowel UK, Disabled Living, Manchester, UK
| | - Eve Hutton
- School of Allied Health Professions, Canterbury Christ Church University, Canterbury, UK
| | - Nicholas Madden
- Children's Surgery, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Anne Wright
- Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Rob Anderson
- Evidence Synthesis & Modelling for Health Improvement (ESMI), University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Stuart Logan
- Peninsula Childhood Disability Research Unit (PenCRU), University of Exeter Medical School, University of Exeter, Exeter, UK.,National Institute for Health Research (NIHR) Applied Research Collaboration (ARC) South West Peninsula (PenARC), Exeter, UK
| | - Jo Thompson Coon
- Evidence Synthesis & Modelling for Health Improvement (ESMI), University of Exeter Medical School, University of Exeter, Exeter, UK.,National Institute for Health Research (NIHR) Applied Research Collaboration (ARC) South West Peninsula (PenARC), Exeter, UK
| | - Christopher Morris
- Peninsula Childhood Disability Research Unit (PenCRU), University of Exeter Medical School, University of Exeter, Exeter, UK.,National Institute for Health Research (NIHR) Applied Research Collaboration (ARC) South West Peninsula (PenARC), Exeter, UK
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Gronski MP. Occupational Therapy Interventions to Support Feeding and Toileting in Children From Birth to Age 5 Years. Am J Occup Ther 2021. [DOI: 10.5014/ajot.2021.049194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Abstract
Evidence Connection articles provide a clinical application of systematic reviews developed in conjunction with the American Occupational Therapy Association’s (AOTA’s) Evidence-Based Practice Program. In this Evidence Connection article, I describe a case report of a young child receiving early intervention services and outline the occupational therapy evaluation and intervention processes for supporting this child’s activities of daily living in the home and early childhood education setting. Findings from the systematic reviews on this topic were published in the March/April 2020 issue of the American Journal of Occupational Therapy and in AOTA’s Occupational Therapy Practice Guidelines for Early Childhood: Birth–5 Years. Each article in this series summarizes the evidence from the published reviews on a given topic and presents an application of the evidence to a related clinical case. Evidence Connection articles illustrate how the research evidence from the reviews can be used to inform and guide clinical decision making.
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Affiliation(s)
- Meredith P. Gronski
- Meredith P. Gronski, OTD, OTR/L, CLA, is Program Director, Methodist University, Fayetteville, NC;
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Raturi S, Li FX, Wong CM. Recognition and management of bladder bowel dysfunction in children with autism spectrum disorder. BMJ Case Rep 2021; 14:14/6/e242646. [PMID: 34078623 DOI: 10.1136/bcr-2021-242646] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Children with autism spectrum disorder (ASD) with rigidities, anxiety or sensory preferences may establish a pattern of holding urine and stool, which places them at high risk of developing bladder bowel dysfunction (BBD). BBD, despite being common, is often unrecognised in children with ASD. With this case report of a 7-year-old girl with ASD presenting with acute retention of urine, we attempt to understand the underlying factors which may contribute to the association between BBD and ASD. Literature review indicates a complex interplay of factors such as brain connectivity changes, maturational delay of bladder function, cognitive rigidities and psychosocial stressors in children with ASD may possibly trigger events which predispose some of them to develop BBD. Simple strategies such as parental education, maintaining a bladder bowel diary and treatment of constipation may result in resolution of symptoms.
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Affiliation(s)
- Shilpee Raturi
- Child Development, KK Women's and Children's Hospital, Singapore
| | - Fay Xiangzhen Li
- Paediatric Surgery, KK Women's and Children's Hospital, Singapore
| | - Chui Mae Wong
- Child Development, KK Women's and Children's Hospital, Singapore
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Perez BC, Morris SL, Bacotti JK, Vollmer TR. Evaluating bowel movements, self-initiations, and problem behavior with the emergence of urinary continence. J Appl Behav Anal 2021; 54:1111-1125. [PMID: 33844291 DOI: 10.1002/jaba.837] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 03/02/2021] [Accepted: 03/02/2021] [Indexed: 11/08/2022]
Abstract
Much of the research evaluating toilet training interventions for children with ASD has focused on urinations as the primary dependent variable. As a result, the effects that toilet training interventions targeting urinations may have on other related dependent variables remains unclear. We conducted a retrospective analysis of data obtained by Perez et al. (2020), who evaluated the effects of a treatment package on urinary continence in children with ASD. We examined the relation between the emergence of urinary continence and multiple nontargeted dependent variables: bowel movements, self-initiation correspondence, percentage of appropriate urinations that were self-initiated, self-initiation rate, and problem behavior. Results showed that improvements in urinary continence were strongly correlated with improvements in all nontargeted dependent variables. Implications for future research and clinical practice are discussed.
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Clark GF, Kingsley KL. Occupational Therapy Practice Guidelines for Early Childhood: Birth-5 Years. Am J Occup Ther 2020; 74:7403397010p1-7403397010p42. [PMID: 32365324 DOI: 10.5014/ajot.2020.743001] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
IMPORTANCE This Practice Guideline provides stakeholders with a condensed summary of a large number of effectiveness studies. It is a valuable tool for facilitating decision making related to occupational therapy interventions for children ages birth-5 yr. OBJECTIVE Early childhood (birth-5 yr) is a critical period in which the foundation of key life occupations is developed (e.g., eating, dressing, play, learning, social participation, rest and sleep, and chores). The development of cognitive, motor, social-emotional, and self-care skills is important to support these occupations. This Practice Guideline synthesizes recent systematic reviews (SRs) on these areas of development to promote decision making for and high-quality interventions with this population. METHOD Four SRs related to cognition, mental health, motor function, and ADLs analyzed studies published from 2010 to 2017 retrieved from six electronic databases (MEDLINE, PsycINFO, CINAHL, ERIC, OTseeker, and Cochrane). RESULTS A total of 196 articles were included in the SRs, which served as a guide to final clinical recommendations. Case studies describe translation and application to practice. CONCLUSION and Recommendations: A variety of interventions within the domain of occupational therapy were found to support the development of cognitive, social-emotional, motor, and self-care skills. Although some of these interventions are typically implemented by occupational therapy practitioners, others can be implemented by parents after training or by teams working in preschool settings. These findings should be used to inform evidence-based practice provided by occupational therapy practitioners working in various early childhood settings. WHAT THIS ARTICLE ADDS This Practice Guideline gives occupational therapy practitioners clear information about which interventions will be effective for specific outcomes. Better intervention choices mean better outcomes for young children and their families.
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Affiliation(s)
- Gloria Frolek Clark
- Gloria Frolek Clark, PhD, OTR/L, BCP, FAOTA, is an occupational therapist in private practice, Adel, Iowa;
| | - Karrie L Kingsley
- Karrie L. Kingsley, OTD, OTR/L, is Associate Professor, Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles
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Pursitasari I, Allenidekania A, Agustini N. Appreciation family support and the abilities of children with special needs to maintain personal hygiene: an Indonesian case study. Pediatr Rep 2020; 12:8700. [PMID: 32905081 PMCID: PMC7463146 DOI: 10.4081/pr.2020.8700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Indexed: 11/23/2022] Open
Abstract
Family support is needed to empower children with special needs to maintain personal hygiene, includes information, instrumental, emotional, and appreciation support. The study design was cross-sectional, involving 84 parents of children with special needs. The study was conducted via the respondents filling out a questionnaire consisting of three sub-questionnaires. The results showed no relationship between the characteristics of children with special needs and personal hygiene; there was also no relationship between parental characteristics and personal hygiene (P>0.05). There was, however, a relationship between information, instrumental, emotional, and appreciation support and personal hygiene (P<0.005), the most influential support being appreciation support. In conclusion, there was a significant relationship between information, instrumental, emotional, and appreciation support and the ability of children with special needs to maintain their personal hygiene. The recommendations for future studies are different research methods to explore more about the types of family support.
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Gronski M, Doherty M. Interventions Within the Scope of Occupational Therapy Practice to Improve Activities of Daily Living, Rest, and Sleep for Children Ages 0-5 Years and Their Families: A Systematic Review. Am J Occup Ther 2020; 74:7402180010p1-7402180010p33. [PMID: 32204772 DOI: 10.5014/ajot.2020.039545] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
IMPORTANCE Research studies supporting occupational therapy interventions to address feeding, toileting, and sleep can be applied to practice in early intervention and preschool settings to improve the outcomes of young children and their families. OBJECTIVE To examine the effectiveness of interventions within the scope of occupational therapy practice to improve activities of daily living, rest, and sleep for children ages 0-5 yr and their families. DATA SOURCES Five databases (MEDLINE, PsycINFO, CINAHL, OTseeker, ERIC) and Evidence-Based Medicine Reviews, Cochrane Database of Systematic Reviews, Cochrane Controlled Trials Register, and Database of Abstracts of Reviews of Effectiveness were searched for studies published between January 2000 and March 2017. STUDY SELECTION AND DATA COLLECTION Inclusion criteria were Levels I-III evidence, being within occupational therapy's scope of practice, including participants with a mean age younger than 6 yr, and addressing self-care, activities of daily living, and rest and sleep. FINDINGS Forty articles were appraised, and three themes emerged: interventions to address feeding and eating, interventions to address toileting, and interventions to address rest and sleep. Additional subthemes of behavioral approaches, parent and caregiver education, and contextual intervention were revealed. CONCLUSIONS AND RELEVANCE Occupational therapy practitioners should consider the use of interventions with moderate or strong evidence as described in this review. Limitations include risk of bias and limited evidence for several interventions. WHAT THIS ARTICLE ADDS This article provides a broader perspective on evidence-based practice by examining studies within the scope of occupational therapy practice published outside of current occupational therapy publications. The review includes studies from nutrition, nursing, and psychology, which address interdisciplinary care, family coaching and education, and behavioral approaches within the professional scope of occupational therapy to improve the functional performance, routines, and quality of life for young children and their caregivers.
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Affiliation(s)
- Meredith Gronski
- Meredith Gronski, OTD, OTR/L, CLA, is Assistant Professor and Chair, Department of Occupational Therapy, Methodist University, Fayetteville, NC;
| | - Meghan Doherty
- Meghan Doherty, OTD, OTR/L, is Assistant Professor, Department of Occupational Science and Occupational Therapy, Saint Louis University, St. Louis, MO
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Snodgrass MR, Chung MY, Meadan H, Halle JW. Social validity in single-case research: A systematic literature review of prevalence and application. RESEARCH IN DEVELOPMENTAL DISABILITIES 2018; 74:160-173. [PMID: 29413430 DOI: 10.1016/j.ridd.2018.01.007] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Revised: 11/30/2017] [Accepted: 01/15/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND Single-case research (SCR) has been a valuable methodology in special education research. Montrose Wolf (1978), an early pioneer in single-case methodology, coined the term "social validity" to refer to the social importance of the goals selected, the acceptability of procedures employed, and the effectiveness of the outcomes produced in applied investigations. Since 1978, many contributors to SCR have included social validity as a feature of their articles and several authors have examined the prevalence and role of social validity in SCR. AIM AND METHODS We systematically reviewed all SCR published in six highly-ranked special education journals from 2005 to 2016 to establish the prevalence of social validity assessments and to evaluate their scientific rigor. RESULTS We found relatively low, but stable prevalence with only 28 publications addressing all three factors of the social validity construct (i.e., goals, procedures, outcomes). We conducted an in-depth analysis of the scientific rigor of these 28 publications. CONCLUSIONS Social validity remains an understudied construct in SCR, and the scientific rigor of social validity assessments is often lacking. Implications and future directions are discussed.
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Affiliation(s)
- Melinda R Snodgrass
- Department of Special Education, Hunter College, 695 Park Ave., Room W929, New York, NY 10065, United States.
| | - Moon Y Chung
- Department of Special Education, University of Illinois, United States
| | - Hedda Meadan
- Department of Special Education, University of Illinois, United States
| | - James W Halle
- Department of Special Education, University of Illinois, United States
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11
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The Assessment and Treatment of Toileting Difficulties in Individuals with Autism Spectrum Disorder and Other Developmental Disabilities. REVIEW JOURNAL OF AUTISM AND DEVELOPMENTAL DISORDERS 2017. [DOI: 10.1007/s40489-017-0107-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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Smith T. Field Report: Making Toilet Training Easier—a Novel Enuresis Alarm System. Behav Anal Pract 2014; 7:31-2. [DOI: 10.1007/s40617-014-0008-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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