Case study on Personal Care (Toileting)

Background

H is a 12 year old boy who has a diagnosis of autism and attends a Special School. He is an engaging child who enjoys listening to dance music and television theme tunes. He is at the pre-verbal language stage, he is currently using a part day object schedule to direct his daily routine with a “Noddy” object to transition him to his schedule.

H.’s parents have begun a toileting programme with him at home and this is also being carried out in school. He is now wearing underwear to school but at home he prefers to wear a nappy.

Triggers

 After consultation with teachers and parents the following triggers were identified.

• H. will urinate in the bathroom area but not in the toilet at school
• H. refuses to wear underwear at home
• H. becomes distressed when he is scheduled to use the bathroom

Strategies

1. Toileting programme is parent/assistant directed as Seth is learning the routine:
2. Object schedule to represent time for toileting both in home and at school (object is a pair of pants)

• Take pants off the schedule and match to receptacle in bathroom
• Parent/Assistant makes reference to vertically placed True Object Based Icon System (TOBIS) on work system which is on wall and places each icon in an all done pocket when they have assisted H. to complete it.

• To encourage H. to urinate in the toilet a musical toileting device is used. This allows a musical tune to be recorded on it and when urinated upon will play the tune. One of his favourite dance songs was recorded on the device

• After toileting H. was directed to an activity which he appears to enjoy; this is displayed on his schedule and also used as a reinforcer within the bathroom area where a first and then board is placed, with a TOBI of first toilet then bubbles

• To encourage H to wear underwear at home and not a nappy, the schedule was used to illustrate underwear and a NO symbol was placed over the nappy. A clock which plays the countdown tune was used as a motivator to encourage H. into the bathroom. This was only used for this purpose to increase motivation to go there

• Cycling shorts were worn over the underwear to create the feeling of deep pressure which the nappy may have been providing

Results

• H. is now wearing underwear both at home and at school. He will occasionally urinate outside of the toilet but this is infrequent. Advice was given to vary the tune recorded in the musical device to keep the process motivating
• H is now removing the TOBIS using the hand over hand approach and placing them in the “All Done” pocket when finished
• H. still requires direction to use the toilet but he is now using the toilet with a higher frequency.

Advice on how to further H.’s independence in toileting:

Teach H. during toileting time to request to use the toilet, using his communication device. (PECS system) – This is to reinforce the life skill of being able to request something from someone, while increasing H.’s independence skills to ask without being directed.