4th Module – Self-care and social skills

2nd Class

Psychologist Esp. Felipe Tardem

1
In this module...
1. Three skill sets and their characteristics: self-care and
autonomy, social, academic.
2. Developing self-care and autonomy: toilet training and
bath
3. Developing self-care and autonomy: eating and brushing the
teeth
4. Promoting social interaction: shared attention and play;
5. Promoting social interaction: expression of feelings and
behavioral flexibility;

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Refreshing the memory
• In the last class, we saw the three sets of skills that
they are usually developed in evidence-based interventions
in Applied Behavior Analysis: of autonomy and
self-care, social, and academic;

• Today, we are going to focus on two self-care skills and

autonomy: bathroom and bathing training!

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But first...
• Before entering teaching strategies for using the bathroom and
bath, I would like to highlight an aspect that we have been talking about since
the beginning of the course;

• ABA is not a ready-made recipe, a package of interventions, it is a

living science, based on research behavioral principles;

• What we are going to do here is suggest broad teaching strategies that

must be adapted to the context and the repertoire of each person with
TEA.
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Toilet training
• The proper use of the bathroom and independent bathing is
a highly self-care and autonomy skill
desirable!

• Next we will see:

1. When to start training;
2. Strategies (routine and chaining);
3. Resolution of common problems.

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Potty training: when to start
• At least 6 prerequisites of the student's initial repertoire are necessary.
when we talk about potty training:

The student follows simple instructions (1 step);

2. Difference between wet and dry;
3. Has communication skills to understand the names of objects
common bathroom items (toilet, flush, toilet paper, sink, etc.)
4. Prefers to be dry than wet;
5. Can pull down and pull up pants;
6. Can hold urine for a short period of time (a few minutes).
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Potty training: when to start
• There are no medical problems (constipation...) or interference from
medications

• It's important to consult a doctor to check if it's safe to start the

bathroom training!

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Toilet training: when to start
• In addition to the student's initial repertoire, the family's life should have themes.
a relatively calm routine (predictable);
• The same applies to schools;

• Toilet training requires:

1. Time;
2. Patience;
3. Consistency.

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Bathroom training: preparation
• First thing: make sure the student likes being in the bathroom;

• The bathroom should be an interesting, fun place!

• The child should sit comfortably in the seat, with their foot
supported on the floor or block!

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Toilet training: preparation
• Select the reinforcers: ideally, they should be of high value.
the reinforcer should only be made available in the bathroom!

• Select the method of communication, verbal vocal (speech), visual (PECS,

signals);

• Identify any particularity of the student: sensory sensitivity,

noise etc.

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Toilet training: preparation
• For 5 days, record the time that the
student: Horário Comer/beber Banheiro
7:00 AM Change of
• Come; diaper
• Baby; 7:30 Fruit and milk
8h00 Change diaper -
• It is exchanged; xixi
• There is a diaper with pee or poop; 8h30 Change diaper
poop
• Rotna is essential at this moment,
check the diaper every 30 minutes;
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 Bathroom training: preparation
Horário Dia 1 Dia 2 Dia 3 Dia 4 Dia 5
7:00 pee giggle xixi • Look for a pattern in the
8h00 Xixi Xixi long of 5 days:
8h30 • Peeing after 10-15 minutes
9h00 to drink something;
9:30 pee xixi Xixi Xixi • Bowel movement every 30-60 minutes
10h00 giggle after eating something;
10h30
11h00 poop poop poop
• These times depend
11:30 poop Poop
12h00
from an established routine.

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Bathroom training: routine
• One of the most important characteristics for potty training is
the maintenance of routine;

• After observing the pattern of pee and poop, establish a routine.

consistent bathroom visits - use an alarm clock to wake you up
remember that it's time for the bathroom.

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Bathroom training: routine
• The proper use of the bathroom will involve, at a minimum, the following behaviors
(task analysis):
Use the bathroom
Enter the bathroom and turn on the light
Pull down the pants
Sit on the toilet
Urinate/defecate
To clean oneself

Lift from the vase

Pull up the pants
Wash your hands
Turn off the light and leave the bathroom

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Toilet training

• After observing bathroom visit patterns, being prepared (with

reinforcers) and the student must meet all prerequisites (if he does not
to possess it is necessary to teach it through formal teaching strategies or
natural), it's time to start the training!

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Toilet training
• Thinking about task analysis, training has 3 basic steps:

1. Teach communication skills that indicate the bathroom:

{"Banheiro":"Bathroom","Vou ao banheiro":"I'm going to the bathroom"}

Sit on the toilet for 2 to 5 minutes:

a) Present relaxing activities (music) and toys that prevent boredom;

Reinforce successes:
a) Powerful reinforcers already selected and praises;
b) Teach to flush!
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Potty training: tips
• Some tips can make training easier, but remember to analyze.
functionally the repertoire of each person with ASD!

Even before the training starts, ask the student to sit on the toilet for
some moments;
Help the student relax, reduce restlessness (e.g. music);
Make sure everyone is speaking the same language: 'pee'; 'poop';
bathroom
Dress the child in a loose outfit (elastic);
No começo, dê mais líquidos e fibras para facilitar o uso do banheiro.
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Bathroom training: out of the routine
• Need to use the bathroom outside of the routine;

• Be aware of signs such as: humidity, restlessness, touching certain areas.

intimate

• Ask if she/he needs to go to the bathroom;

• Take him to the bathroom quickly! The more proper use,

better!
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Potty training: accidents
• Accidents happen!

• If the accident is happening:

• Take the student hurriedly to the bathroom;
• If it is possible to turn the accident into appropriate use: reinforce and praise;

• If the accident has already happened:

• Take the student calmly to the bathroom and change them;
• Pay the minimum attention: avoid eye contact, conversations, comfort;
• DO NOT be aversive! Do not punish or threaten! Our focus is on reinforcement!
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Toilet training: diapers vs. underwear
• As soon as potty training begins to be implemented, there arises the
Question: Should I keep the diaper or switch to underwear/underpants?

Diaper Briefs/panties
Pros Easy to clean Easy to verify an accident;
Create new rules ('Now I use')
"underwear/panties and I'm going to the bathroom"

Difficult to verify an accident; More mess/dirt to clean

It can confuse the child ('the diaper
‘And where I always peed/pooped’

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Bathroom training: record
• As in all teaching programs, record the: successes,
accidents turned into success, and accidents!
• This will show you the progress throughout the training and will serve as a basis for the
gradual withdrawal of aid;
Evento Horário Tipo: (1) Sucesso / (2) Started Notes
Conversion/ independent
(3) Accident
1 (1) / (2) / (3) ( ) Yes / ( ) No
2 (1) / (2) / (3) ( ) Yes / ( ) No
3 (1) / (2) / (3) ( ) S / ( ) N
4 (1) / (2) / (3) ( ) Yes / ( ) No
... ... ...

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Bathroom training: record
• Transform the records into graphs, in Excel or by hand (paper
checked;

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Toilet training: assessment
• The potty training lasts, on average (remember the
particularities), from 3 to 6 weeks;

• During this period:

• Change the reinforcers:
Keep the student motivated;
• Be consistent!

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Toilet training: common problems
• There are two common problems when potty training begins:

• The child seems to have fun with the accidents (pee and poop in the pants)
• Consider the amount of attention that is being paid during accidents (even if it is for the
disapproval
• Make the bathroom more fun than the accidents, use powerful reinforcers!

• The student does nothing in the potty, but as soon as I put the diaper on, he does it.
• Historically, the diaper is a precursor to doing one's needs;
• Diapers absorb moisture and make accidents more 'comfortable';
• Consider switching to underwear/ panties.

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Bath training

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Bath training
• Another very important skill to promote autonomy and
self-care is taking a shower independently;

• 5 prerequisites are necessary for bathing training:

The student must follow simple instructions;
2. Has communication skills to understand the names of objects
common items for bathing (soap, sponge, to scrub, head, arms, belly, etc.)
3. Differentiate right side and left side;
4. Participate in the bath in a calm manner;
5. Can you undress and dress?

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Potty training: when to start
• In addition to the student's initial repertoire, the family's life must have themes.
a relatively calm (predictable) routine

• The bathing training requires:

1. Tempo;
2. Patience;
3. Consistency.

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Bathing training: preparation

• Again:
• Select the reinforcers: ideally, they should be of high value.
reinforcer and only be made available in the bathroom!

• Select the communication method, verbal vocal (speech), visual (PECS,

signs);

• Identify any particularity of the student: sensory sensitivity,

noise etc.
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 Bathing training: task analysis
Bath training Continuation... Bath training
Enter the bathroom and turn on the light Rubbing the belly Enter the bathroom and turn on the light
Take off the shoe Scrubbing the back Take off the shoe
Take off the sock Rinse the belly and the back Take off the sock

... Scrub the right arm ...

Rub the left arm
Enter the box Enter the box
Rinse the right and left arm
Turn on the shower (hot/cold) Turn on the shower (hot/cold)
Rub the right leg
To get wet Get wet
Rinse the right leg
Put soap on the sponge Put soap on the sponge
Rub the left leg
Rubbing the neck Rinse the left leg Scrubbing the neck
Rinse the neck Rub the right foot Rinse the neck
To rub the chest Rinse the right foot Scrub the chest
Rinse the chest Rinse the chest...

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Bathing training: task analysis
• After analyzing all the components of the bath, and preparing all the reinforcements and
materials, determine the level of help needed and the duration of each one of them
components over at least 5 baths:

Component Help Duration (min)

Enter the box Independent 0:30
Turn on the shower (hot/cold) Partial Physics 0:10
To get wet Partial Physics 1
Put soap on the sponge Gestural Physics 0:30
... ... ...

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Toilet training
• Establish a routine for bath time;

• Plan the fading of assistance gradually and following the levels.

of the hierarchy defined for each of the aids;

• Advance from the most invasive help to the least invasive (e.g. visual cues not
they require the presence of parents/caregivers;

• Create a motivating environment, reinforce every small advance and do not give up.
attention to inappropriate behaviors.
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Bathroom training: record
• The recording of the hint level and its changes is essential for the
the training progress should be monitored!

• Again, turn the records into graphs - visual information,

intuitive

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Bath training: common problems
• A common problem in bath training is the dependence on cues;

• Remember that the goal is to develop behaviors.

independents that promote autonomy and self-care;

• Planning the gradual fade of tips and the fading of the model is
essential for the independent bathing behavior to be
established.

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Recapping
• In this lesson, we saw common strategies and problems of two
skills that make up self-care skills and
autonomy: bathroom and shower!

• If possible, review the content of teaching strategies and usage of

help/tips;

• In the next class, we will see strategies for two more skills.
about important self-care and autonomy: eating and brushing teeth.

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