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Toilet training children with special needs using a Potty Monkey toy device
Abstract
Aim
Toilet training children with special needs can be challenging and can result in long‐term consequences if inadequately addressed. This study evaluates the use of a ‘Potty Monkey’ toy for toilet training children with special needs.
Methods
A pilot study using a ‘Potty Monkey’ to model timed voiding in children with special needs. We collected parental feedback and examined the experience of families using a ‘Potty Monkey’ to toilet train their child. Using logistic regression we explored patient factors for association with outcomes.
Results
Of 21 children in our study, 15 were male. Age ranged 4–10 years (median 6.3 years). Days that ‘Potty Monkey’ was used ranged 0–156 (median 22 days). At 6 months, nine children had improved, five were unchanged and four were worse (three were unknown). We found no evidence of association between patient factors (age, gender, days using ‘Potty Monkey’, baseline toileting ability, Paediatric Incontinence Questionnaire score) and toileting outcome. The experience of families was ambivalent. 10 families reported ‘Potty Monkey’ had been helpful however many complained it interfered with family schedules. Reasons for the child not responding positively were due to sensory issues, embarrassment and being developmentally not ready. Our study demonstrated the practical challenges of conducting research among children with special needs.
Conclusion
Although some children's toileting improved after using ‘Potty Monkey’, we are uncertain ‘Potty Monkey’ is effective for toilet training children with special needs.
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To directly address the challenge of toilet training for children with cerebral palsy, providers at a Midwest multidisciplinary center initiated a medical pathway to assist providers with identifying presumed medical, physical, and psychosocial barriers to functional toileting. Using a multidisciplinary clinical pathway, common barriers to toileting were identified and treated, and behavioral interventions for toilet training were implemented (if indicated). Data from 5 participants, (mean age of 5 years, 9 months) who completed the pathway were analyzed. Participant progress was assessed using scores from 4 toileting domains of the Functional Independence Scale for Children (WeeFIM), which measures level of independence/assistance with activities of daily living. All participants increased their WeeFIM scores in at least 1 toileting domain, 80% increased in at least 2 domains, and 40% increased in all 4 domains monitored. The average increase on the WeeFIM scales was 3.08 points on a 7-point scale. These results were clinically significant but not statistically significant. (PsycINFO Database Record (c) 2013 APA, all rights reserved)
We evaluated quality of life in children with urinary incontinence using a disease specific tool (Pediatric Incontinence Questionnaire) and determined factors that decrease quality of life in affected children.
The Pediatric Incontinence Questionnaire was self-administered by children 6 to16 years old with urinary incontinence while attending outpatient clinics at a tertiary pediatric hospital in Australia between October 2009 and May 2010. A weighted summative quality of life score with a range of 1.75 to 7 (7 being lowest quality of life) was generated, and patient characteristics (age, gender, ethnicity, symptom severity) were evaluated as potential predictors.
Of 146 children invited to participate 138 consented (response rate 95%). About half of the participants (77) were boys, and mean patient age was 10 years. Girls had a lower quality of life than boys (mean score 3.60 vs 3.31, 95% CI 0.10-0.57, p=0.04), and nonwhite children had a lower quality of life than white children (3.97 vs 3.35, 95% CI 0.23-0.99, p<0.01). Older age (r=0.21, p=0.01) but not increasing symptom severity (r=0.15, p=0.09) or underlying chronic disease (difference 0.12, p=0.91) was correlated to decreased quality of life. Multivariate regression analysis demonstrated that older age, nonwhite ethnicity and female gender were independent predictors of decreased quality of life.
Older age, female gender and nonwhite ethnicity are associated with a lower disease specific quality of life in children with urinary incontinence. Clinicians need to be aware of the differential effect of urinary incontinence in children of different ages and ethnic backgrounds.
To examine the impact of a range of early childhood factors on the risk for daytime wetting and soiling.
This is a longitudinal study based on a UK population of over 10,000 children from age 4 to 9 years. Parents completed questionnaires on child development (at 18 months); child temperament (24 months); maternal depression/anxiety (21 months), and parenting behaviors (24 months). The analysis examined whether these risk factors distinguish between children with normal development of daytime bladder and bowel control and those with delayed acquisition of daytime continence; persistent daytime wetting/soiling, and relapse in wetting/soiling.
Delayed development, difficult temperament, and maternal depression/anxiety were associated with an increase in the odds of experiencing problems with bladder and bowel control.
The current findings provide evidence that risk factors in early childhood are associated with a subsequent increase in the odds of children experiencing daytime wetting and soiling at school age.
Aims:
To assess the rates of incontinence and associated psychological problems in children, adolescents and adults with Down Syndrome, a genetic syndrome caused by partial or complete triplication (trisomy) of chromosome 21 and characterized by typical facial features, a physical growth delay and mild or moderate intellectual disability.
Methods:
Three hundred and seventeen persons with Down Syndrome (4-51 years) were recruited through a German parent support group (59.6% male, mean age 19.2 years). The Parental Questionnaire: Enuresis/Urinary Incontinence, the Incontinence Questionnaire-Pediatric Lower Urinary Tract Symptoms, as well as the Developmental Behavior Checklist (DBC) for parents or for adults were filled out by parents or care-givers.
Results:
17.2% of the sample had nocturnal enuresis, 15.9% had daytime urinary incontinence, and 14.2% had fecal incontinence. Incontinence was present in 64.0% of young children (4-12 years), 10.3% of teens (13-17 years), 12.8% of young adults (18-30 years) and in 22.4% of older adults (>30 years). 13.6% of children and 8.4% of adults had a DBC score in the clinical range. 19.5% of children and 27.8% of adults with incontinence had behavioral problems. There was a significant association between nocturnal enuresis, daytime urinary incontinence and clinical DBC scores in adults.
Conclusions:
Incontinence in Down Syndrome is mainly present in young children and increases in older adults. Behavioral comorbidity is associated with incontinence only in adults with Down Syndrome. Screening and treatment of incontinence in individuals with Down Syndrome is recommended.
Toilet training is one of the key developmental milestones of early childhood and there is growing evidence that it is now being initiated later than it was 50 years ago. This article explores the reasons why this is happening and considers the effect on children with autism and related conditions. It also examines the literature to discover the approaches to toilet training for this group. Research into this area has generally focused on small numbers of children and incorporated modified versions of Azrin and Foxx's ( 1971 ) rapid toilet training method. Suggestions are offered about the most appropriate advice to give parents and carers of children with autism and related disorders, and the importance of addressing toilet training at an early stage.
Aims:
To review studies on the associations of incontinence and special needs in children and adults and to outline future directions in research and clinical care.
Materials and methods:
A review of literature was conducted. Open questions and future directions were discussed during the ICI-RS meeting in 2014.
Results:
Special needs comprise a wide variety of conditions and disabilities. Individuals with special needs carry a greater risk for all types of incontinence. There is a high tendency for incontinence to persist from childhood into adulthood. Many people do not receive adequate medical care for their incontinence.
Conclusions:
More detailed research is needed, especially in the adult population with special needs. Assessment and treatment of incontinence should be offered routinely to all those with special needs.
Autism spectrum disorder (ASD) and incontinence (nocturnal enuresis (NE), daytime urinary incontinence (DUI), fecal incontinence (FI)) are relevant disorders in childhood. In general, children with special needs such as intellectual disability (ID) or ASD are more often affected by incontinence than typically developing children.
In the few studies conducted on children with ASD, gastrointestinal (GI) symptoms have received more attention than NE, DUI and lower urinary tract symptoms (LUTS). The aim of the present study was to assess the prevalence of incontinence, LUTS and psychological symptoms/disorders in children with ASD compared to controls.
Forty children with ASD (12 children with infantile or childhood autism, 15 with atypical autism and 13 with Asperger's syndrome) (mean age 11.3 years) and 43 age-matched control children (mean age 10.7 years) were assessed. A questionnaire referring to incontinence and the International Consultation on Incontinence Questionnaire-Pediatric LUTS (ICIQ-CLUTS) were administered. Child psychopathology was assessed with the Child Behavior Checklist (CBCL/4-18). Child psychiatric ICD-10 diagnoses were based on a structured psychiatric interview (Kinder-DIPS).
Children with ASD showed increased rates of NE (30.0% vs 0%) and DUI (25.0% vs 4.7%) compared to controls. Among children with ASD, daytime bladder control (≥5 years of age: 20.5% vs 0%) and bowel control (≥4 years of age: 42.5% vs 7.5%) were delayed compared to controls. Children with ASD had a higher LUTS score. Additionally, children with ASD were more often affected by psychological symptoms and disorders. Rates of clinically relevant externalizing symptoms (32.5% vs 0%), internalizing symptoms (67.5% vs 9.3%) and total problem score (70.0% vs 2.1%) were higher in children with ASD than the controls (see table). Children with ASD had more ICD-10 diagnoses than the controls (47.5% vs 4.7%).
The present study showed that children with ASD are more at risk of DUI and NE than healthy controls. In addition, children with ASD had more LUTS, especially urgency and postponement, and they needed a longer time to become dry and continent. Additionally, according to the parental CBCL questionnaire, children with ASD showed higher rates of clinically relevant psychological symptoms (externalizing and internalizing symptoms), and according to the psychiatric interview, they had higher rates of comorbid psychological disorders.
Autism spectrum disorder is an incapacitating disorder with significant impairment in social functioning. In most cases, psychological symptoms and disorders co-occur. Additionally, children with ASD are at a greater risk of being affected by different forms of incontinence and LUTS. Therefore, screening for incontinence and, if indicated, treatment of these disorders is recommended.
Copyright © 2015 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.
Nocturnal enuresis, daytime urinary incontinence, lower urinary tract symptoms and faecal incontinence are more common in children with special needs than in typically developing children. Children with intellectual disability, which can be attributed to a range of causes, are particularly affected. Indeed, the epidemiological and clinical studies conducted to date show clear associations that children with special needs have higher rates of urinary (and faecal) incontinence than children without development, physical or cognitive impairments. For example, low intelligence quotient (IQ)-associated physical disability and conditions such as Fragile X and Rett syndromes increase the risk for incontinence, which can persist into adulthood if left untreated. Although the association of attention deficit hyperactivity disorder and incontinence has been shown in many studies, further research is needed on other specific disorders, such as autism. As many children are not receiving adequate care, specific multimodal treatments based on rigorous assessment of the incontinence, underlying condition and associated comorbid disorders should be actively offered.
Toilet training children with learning disabilities can present challenges and requires careful assessmentand management. This article examines strategies for toilet training using a five step approach bladder and bowel control.
Little is known about the levels of continence in children with cerebral palsy and what factors affect this. This study was conducted to determine levels of urine and stool continence in children with cerebral palsy in relation to their learning disability (LD) and mobility. The aim was to enable us to predict level of continence that can be achieved for these children with a given level of learning disability and mobility. Data were obtained from medical notes and by telephone interview on mobility, degree of learning disability and urine and stool continence of 55 children in Southern Derbyshire. Most of the children who have nil to moderate disabilities in learning and mobility were able to achieve a decent level of continence around a median age of three years. Therefore, their toilet training should be started at the usual age with ongoing support from parents/carers. In children with severe learning disability and severe immobility, the probability of continence is very slim after the age of eight years. After this age it may be better to divert resources to other aspects of care, for example nutrition and physiotherapy, to improve their quality of life.
This study examined the relationship between toileting concerns, behavior problems, and parenting stress in parents of children with special health care needs (CSHCN). Participants included parents of 99 males and 71 females aged 4 to 12 years with neural tube defects (NTD), developmental-behavioral disabilities (DBD), or history of perinatal intraventricular hemorrhage (IVH). Parents completed the Achenbach Child Behavior Checklist (CBCL) and the Parenting Stress Index-Short Form (PSI-SF). Parents expressing toileting concerns on the CBCL reported significantly more personal distress and more externalizing problems versus those with continent children. Variation within subsamples suggested that expectations based on nature of disability may be a factor in parent adjustment. Direct assessment and intervention of toileting issues should be a high priority in secondary stress prevention with CSHCN and their families.