A pilot investigation of an iOS-based app for toilet training children with autism spectrum disorder.

We developed an iOS-based app with a transmitter/disposable sensor and corresponding manualized intervention for children with autism spectrum disorder. The app signaled the onset of urination, time-stamped accidents for analysis, reminded parents to reinforce intervals of continence, provided a visual outlet for parents to communicate reinforcement, and afforded opportunity for timely feedback from clinicians. We compared this intervention with an intervention that uses standard behavioral treatment in a pilot randomized controlled trial of 33 children with autism spectrum disorder aged 3-6 years with urinary incontinence. Parents in both groups received initial training and four booster consultations over 3 months. Results support the feasibility of parent-mediated toilet training studies (e.g., 84% retention rate, 92% fidelity of parent-implemented intervention). Parents used the app and related technology with few difficulties or malfunctions. There were no statistically significant group differences for rate of urine accidents, toilet usage, or satisfaction at close of intervention or 3-month follow-up; however, the alarm group trended toward greater rate of skill acquisition with significantly less day-to-day intervention. Further development of alarm and related technology and future comparative studies with a greater number of participants are warranted.

Utensil manipulation during initial treatment of pediatric feeding problems.

Children with feeding disorders exhibit a variety of problem behaviors during meals. One method of treating problem mealtime behavior is to implement interventions sequentially after the problem behavior emerges (e.g., Sevin, Gulotta, Sierp, Rosica, & Miller, 2002). Alternatively, interventions could target problem behavior in anticipation of its emergence. In the current study, we implemented nonremoval and re-presentation of bites either on a spoon or on a Nuk for 12 children with feeding problems. The nonremoval and re-presentation treatment improved feeding behavior for 8 of 12 children. Of those 8 children, 5 had lower levels of expulsions, and 4 of the 8 children had higher levels of mouth clean with the Nuk than with the spoon. We describe the subsequent clinical course of treatment and present follow-up data for 7 of the 8 children who responded to the nonremoval and re-presentation treatment with the spoon or Nuk. The data are discussed in terms of potential reasons why the utensil manipulation improved feeding behavior for some children.

Chin prompt plus re-presentation as treatment for expulsion in children with feeding disorders.

Expulsion (spitting out food) is a problem behavior observed in many children with feeding disorders. In the current investigation, we identified 4 children diagnosed with a feeding disorder who exhibited high rates of expulsion. Treatment with re-presentation (placing expelled liquids or solids back into the child's mouth) was not effective in reducing expulsion. Therefore, we added a chin-prompt procedure (the feeder applied gentle upward pressure to the child's chin and lower lip) for the initial presentation and the re-presentation. Chin prompt plus re-presentation resulted in low rates of expulsion for all 4 children. The results are discussed in terms of the potential underlying mechanisms behind the effectiveness of the chin-prompt procedure.