Introduction- Problem, Significance, & important research findings

Video based models have successfully been implemented in toilet training children with autism. Past studies have found that children with autism suffer from slow development in terms of attaining necessary life skills. The acquisition of toileting techniques is one of the areas in which children with autism experience slow development. Autistic children continue to face challenges in attaining independent toileting thus requiring services of caregivers. This development has resulted in negative personal hygiene as well as physical discomforts and reduced levels of self-esteem among the autistic children. In a bid to solve the problem, various concepts geared towards the solution of the problem have been floated. Although the problem of toileting challenges has been explored in subsequent studies, concrete results have not been identified (Drysdale et al., 2014). Additionally, most of the studies are focused on addressing the attainment of these techniques with no focus on the eradication of the real problem. Consequently, the problem presents numerous challenges to the affected students as they cannot partake in education effectively.

Today, video modeling is one of the most applied methods of training children with autism how to use the toilet. However, the results have not been encouraging as far as improvements are concerned. Some children with autism face delayed toileting acquisitions with others never attaining the skill (Lee et al., 2014). This scenario has raised concern on the effectiveness of video modeling in the toilet training of children with autism. The problem is highly significant in understanding the issues that children with autism face. In addition, the results of this study will contribute to the improvement of the education potential of these children as they can comfortably attend classes. This review paper is thus important in pointing out the existing problem and identifying the applicability of the proposed solutions. The identification of the problem and the eventual solution is significant as it will help in bettering the lives of thousands of students with autism. By effectively highlighting the effectiveness of video modeling techniques, the paper presents an opportunity for the enhancement of educational standards among children with autism.

Purposes

The purpose of this review study is to describe and analyze research findings of using video-based toilet training techniques for children with autism. The review aims to propose educational implications for both parents and teachers regarding the problem and its solution. This review paper is purposed towards ascertaining whether video modeling can be used in toilet training children with autism. Consequently, the main purpose of the review paper is to gauge the effectiveness of video modeling in its application to toilet train children with autism. The paper will further review the effects that video modeling has while toilet training children with Autism. This will be done by evaluating an intervention package, which is designed to teach toileting skills to children with ASD. The video-modeling will utilize prompting, animation and reinforcement procedures. The different needs of children with autism will be explored before analyzing how video modeling can meet these needs.

In meeting its purpose, the paper will specifically explore findings from past studies on the subject. In particular, the paper will describe specific research findings pertaining to the topic under analysis. Among the findings that are going to be discussed is the one documented findings by Drysdale et al. (2015), which assesses the effect of video modeling on two boys diagnosed with ASD, and their quest to increase independent toileting skills. The subject of autism will be analyzed in detail with respect to the effectiveness of video modeling in toilet training. In particular, the paper shall explore the specific effects of video modeling on toilet training of autistic children. Eventually, the review paper will come up with recommendations on how the concept can best be used in toilet training. The paper anticipates to contribute to the literature available with regards to autism in children and the effectiveness of video-based toilet training.

Research Questions

The review study will be guided by two research questions related to the subject under investigation. The selection of these research questions is based on their relevance to the subject under discussion and the frequency in past studies. Consequently, the research questions are important as they form the backbone of the study including the determination of the methodology in use. This paper purposes to answer the research questions in a detailed fashion by evaluating the findings from past literature. A comparison, evaluation, and description of the different research papers under review will be conducted in line with the research questions. The aim of this study is to, therefore, answer the following research questions:

• Can video modeling be used to toilet train a child with autism?
• What are the effects of video modeling on toilet training a child with Autism?

Description, Comparison, and Evaluation

Article Descriptions

All the articles are focused on the subject of toilet training among children with autism. The nature of these studies is based on the need to solve the challenges faced by the children and help in improving the learning process. Lee et al., (2014) explore the possibility of using video modeling in toilet training children with autism. The article is an experiment of the effects of an instructional package that uses incorporates the use of custom designed video models. The set up is tested for its effective in incorporating reinforcements and picture prompts to train a 4-year old child with autism on how to use the toilet. First, the study identifies six aspects of toileting including walking to the toilet, undressing, sitting on the toilet, elimination in the toilet, redressing as well as flushing. The study used a changing criterion design in assessing the effects of the intervention with the results showing positive signs of effectiveness. Despite the effectiveness, the intervention failed in imparting in-toilet voiding skills in the child.

In the next paper, Wang & Koyama (2014) embark on a review and analysis of the available literature of the three-tier video modeling intervention model. The paper had two objectives: to analyze and review the available literature on the characteristics of video modeling interventions and the components for assisting research and practice; as well as develop a three-tier model to assist in the same. The study explores past literature on the topic of video modeling for toilet training children with autism. Indeed, the study appreciates that the effectiveness of these interventions has been assessed in most of these studies. Nonetheless, children with autism do not necessarily gain the skills nor respond to the interventions in similar anticipated ways. In addition, most of the parents and educators cannot afford the required treatments thus leaving a lot of children in problematic states. The research employs a three-tier approach that incorporates self administered generic video modeling with group based instruction as well as individually administered video modeling. This approach is different and unique as it encourages self-administration of the intervention.

Still, McLay et al., (2015) extended the research on the video modeling intervention in toilet training two individuals with autism. The paper is an evaluation of the impacts of the video modeling package that was designed to instill toileting skills among children with autism. In this instance, the intervention largely depended on animation to depict the concepts of prompting, reinforcement as well as in toilet voiding procedures. However, the design used was based on the selection of participants through a non-current multiple baseline procedure. The findings of the study reported significant success in teaching the children basic toileting techniques including undressing, sitting on the toilet, flushing and dressing. In fact, the components taught through this intervention are similar to those discussed in Lee et al. (2014). Both boys maintained the skills for a period of over there to four months in their stay within the school. Also, the intervention is attributed with instilling the skill of in-toilet defecation for one of the boys.

Almost similar approaches are used in Drysdale et al., (2014) in test of video modeling interventions using animations in toilet training two children with autism. In similar fashion, a design of multiple baselines across behaviors was used in the experiment. However, this experiment incorporated both animated and real models coupled with a chaining procedure. The results portray a significant success in imparting toileting techniques of walking to the toilet, undressing and urinating on the toilet. Also, the study attained success in the skills of redressing and flushing over an extended period of four weeks. After the experiment, it was observed that both participants could exhibit the acquired skills successfully. The study provides sufficient evidence of the success of video modeling techniques of toilet training. In particular, the use of animation is explored with respect to the ease of administering toileting techniques and skills to children with autism.

Still, Rayner (2014) assesses pre-requisite imitation skills in the improvement of video based models of toilet training children with autism. While other studies have focused on the interventions effectiveness, this paper explores the link between video based models in children with autism and the responses to imitation assessment. The methodology in use was also different as the current study based its methodology on imitation assessments that were based on observations as well as interviews of five boys. The paper also made comparisons between video based models of animated features and those baring human features. It was observed that participants with high and strong imitation skills were more likely to respond positively to video-based interventions. However, the paper failed in identifying any differences in the responses between animated and human models in the boys. Consequently, the paper finds that the level of imitation skills is dependent on the target behavior in the children with autism. The paper thus recommends that prior imitation assessment be revised as well as validation and development of comprehensive measures before their use in line with video based models.

The last paper by Szyndler (1996) explores the different toileting problems facing children with autism as well as their families. In the experiment, researchers interviewed 33 families out of the 39 families that were enrolled in a support group for parents of children with autism. The paper sought to identify the different toileting problems associated with children suffering from autism. In the course of the research, children with autism were classified into three categories including the untrained forming 125 of the total. Also, those that were out of nappies for most of the day but required prompting made up 33% of the total population. Lastly, 55% of the population was fully continent. The paper then discusses the different problems attributed to the different groups with a focus on the management strategies and preventative measures. In all these participants, more than 82% of the parents reported toileting difficulties in their children. In particular, the children had severe difficulties in learning effectively affecting the degree of attainable independence. The paper continues to explore and address particular problems evidenced in some of the most able children.

Comparisons

In the six papers, the basic structure of the research is similar and underlies the prospects of video-based interventions in toilet training children with autism. It is observed that the nature of the research question affects the methodology and research design in use. For instance, Rayner (2014) purposes to explore the relationship between responses to imitation assessment and video based models in children with autism. This objective calls for the use of observation based imitation assessments coupled with interviews to attain the research objective anticipated. In Szyndler (1996) however, the research question is simple and calls for a descriptive research model. It aims at identifying the toileting problems in a group of children with autism. The descriptive nature of the research required the use of questionnaires in collecting the necessary data. Some of the papers hypothesized that the use of video models would lead to the attainment of toileting skills among children with autism (Drysdale et al., 2014). This called for the use of a multiple baseline across behaviors design. The same approach was used ion McLay et al., (2015) where the use of animation was touted as having a significant effect on urination and defecation in children with autism. Lee et al., (2013) hypothesized that the use of video modeling would result in the attainment of toileting techniques that would be maintained for a long time. Wang & Koyama (2013) on the other hand, aimed to test the effectiveness of a three tier video based model on imparting toileting techniques on children with autism.

The results from the studies are equally similar with respect to video-based interventions. In fact, only one of these papers is different in scope thus yielding different results. Lee et al (2013) observe that the intervention package is effective in teaching the functional skills of dressing, sitting on the toilet and flushing. These results are similar to those identified in McLay et al. (2015). However, the latter included behaviors such as walking to the toilet, undressing, sitting on the toilet and redressing. Similar results were identified in Drysdale et al. (2014) as the proposed intervention observed success in reduction of the number of prompts necessitated by the toileting experience. Indeed, the participants had reduced prompts in walking to the toilet, undressing, sitting on the toilet, redressing and flushing. These components are similar to the ones identified in the subsequent studies thus pointing to a kind of uniformity in the results observed. The results of Wang & Koyama (20150 were somewhat different as they observed insufficient information regarding the intervention characteristics selected in the analyzed studies. On the contrary, Szyndler (1996) observed that more than 82% of the children with autism were faced with toileting problems which affected their learning outcomes. Also, participants with strong imitation skills were observed to have a higher likelihood of positive response to video based models (Rayner, 2014).

In most of the studies, the participants were children with autism with a majority of these studies incorporation boys. It is no wonder that the video-based interventions sometimes attained success in urination while recording minimally low success in defecation. The number of participants was, however, different ranging from one in Lee et al. (2013) to 33 in Szyndler (1996). Rayner (2014) employed five boys with autism in undertaking the study while Wang & Koyama (2014) was a review of different studies comprised of a different number of participants. As such, the study did not have a physical exact number of participants but relied on those used in previous studies. Both McLay et al. (2015) and Drysdale et al. (2014) employed the use of two boys diagnosed with autism. Indeed, the number of participants did affect the results identified in each of the studies and also the overall representative mix. For instance, in one of the studies that used two boys, it was observed that one boy had gained the skills of defecation thus resulting in inconclusive results on the study.

The instruments used were also different and were dictated by the nature of the research questions identified in the studies. Drysdale et al. (2015), for instance, conducted baseline, intervention as well as follow-up sessions in each of the participants’ home. The videos were done in the living room of the children’s homes due to its proximity to the toilet. Similarly, McLay et al. (2015) employed baseline, intervention and follow-up assessments at the children’s homes. However, the generalizations were done at the children’s school bathroom which was located just next to the classroom. In Lee et al. (2013) the three stages, as well as the video production, was done at the child’s home at the living room which was about 5 meters from the toilet. Just like the other studies, the generalization sessions were conducted in the bathrooms of the special school that the child attended. The choice of location in these studies point to a desire to use the child’s home in teaching the videos due to the aspect of comfortability. Also, the toilets used are either located within the child’s home or within their skills at a location of fairly short distance from their classroom or home.

Study Evaluation

The acquisition of toileting techniques is one of the areas in which children with autism experience slow development. Autistic children continue to face challenges in attaining independent toileting thus requiring services of caregivers. The studies were all highly effective in attaining the objectives set aside prior to the research. However, there are strengths and weaknesses to be identified in each of these studies stemming from the methodology used or the instruments in use. In Drysdale et al. (2015), the objective is attained with the results confirming the hypothesis formulated. Also, the use of animation is a source of strength as children are more likely to associate with animated videos. However, the paper was short of perfect as seen in the limitations of the methodology. The study should have been conducted over a longer period to ascertain the permanent nature of toileting skill acquisition. Still, McLay et al. (2015) attained their respective objectives as evidenced by the results presented. In fact, the use of two children in testing the hypothesis is quite rewarding although it was also a source of confusion. The research finds that defecation skills were attained in one of the participants and not in the other.

Lee et al., (2013) was equally effective in answering the research questioned posed at the start of the study. Although the study used one child with autism, it contributed to the existing body of literature through its findings. Further, the components identified for study provided a source of strength as they resonated with those used in past studies. Walking to the toilet, undressing, sitting on the toilet, redressing and flushing are some of the conventional components used in the study. However, the study faced weaknesses by using one child thus not presenting results that were representative of a wider selection. Wang & Koyama (2014) was perhaps the most effective owing to a shift in study design. The paper reviewed past literature thus coming up with the most representative results drawn from all the past studies. The development of a video modeling intervention comprising of three tiers was equally effective. However, the study did not have physical participants, and the results could as well be misleading as they are drawn from other past studies.

Szyndler (1996) sought to identify the toileting problems in a group of children with autism. As such, the nature of the study was descriptive and only aimed at identifying the specific problems while proposing recommendations to address the same. The approach in use is highly effective as identification is quite straightforward. Further, the number of participants is relatively higher at 33 considering that other studies used an average of two participants. The high number of participants provides a more accurate account of the toileting challenges facing children with autism. In Rayner (2014), the relationship between responses to imitation assessment and video based models was sought. This is a shift from the norm as most studies researched on the effectiveness of the interventions. In essence, therefore, the current study was better versed and poised to attain positive results. However, the challenge with the study lies in complexity with which it is done making it more time consuming.

Findings and Implication

The review paper was highly successful in attaining its purpose of describing and analyzing research findings of using video based toilet training techniques for children with autism. The paper finds that video based interventions are highly significant ion improving toileting techniques among children with autism. The components of walking to the toilet, undressing, in-toilet voiding, redressing, flushing and walking back are bound to gain from these interventions. Children with autism have been found to benefit from video based interventions that teach them how to use the toilet. Most effective, perhaps is the use of animations in the videos to communicate to the children as they associate with the content easily. The results from the review dictate that both human and animations have an impact on the attainment of toileting skills when incorporated in the video models (Lee et al., 2014). In addition, the use of visuals in training is most effective especially when the training involves children. Ultimately, most children with autism benefit from videos based interventions as they can relate better with the visuals in the videos.

The implications of the review study have far reaching consequences on the concept of video modeling in toilet training children with autism. The purposes of the study have been attained through the review and subsequent discussion. Indeed, video modeling is one of the most applied methods of training children with autism how to use the toilet. All the study papers point to the effectiveness of video based models of toilet training children with autism. The different sections touch on different aspects of the studies and are guided by different outcomes. Consequently, the problem was initially identified and the significance of the review outlined. Also, the purpose of the study is defined at the start of the paper and attained through subsequent discussions. The six studies identified are then described in detail and their key elements identified. A comparison of the different aspects of the studies portrays an interrelationship in the methodology used as well as the scope of the studies. Moreover, the evaluation of the different studies point to the different strengths and weaknesses identifiable with each study.

References

Drysdale, B., Lee, C. Y. Q., Anderson, A., & Moore, D. W. (2015). Using video modeling incorporating animation to teach toileting to two children with autism spectrum disorder. Journal of Developmental and Physical Disabilities, 27(2), 149-165.

Lee, C. Y. Q., Anderson, A., & Moore, D. W. (2014). Using video modeling to toilet train a child with autism. Journal of Developmental and Physical Disabilities, 26(2), 123-134.

McLay, L., Carnett, A., van der Meer, L., & Lang, R. (2015). Using a Video Modeling-Based Intervention Package to Toilet Train Two Children with Autism. Journal of Developmental and Physical Disabilities, 27(4), 431-451.

Rayner, C. (2015). Video-based intervention for children with autism: Towards improved assessment of pre-requisite imitation skills. Developmental neurorehabilitation, 18(2), 113-121.

Szyndler, J. (1996). Toileting problems in a group of children with autism. Child Psychology and Psychiatry Review, 1(1), 19-25.

Wang, H. T., & Koyama, T. (2014). An analysis and review of the literature and a three-tier video modeling intervention model. Research in Autism Spectrum Disorders, 8(7), 746-758.

 
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