Part 1: Introduction

Filmed October 2021 – edited into 7 parts; total 184 minutes

A significant percentage of children and adults diagnosed with autism have great difficulty achieving healthy sleep patterns and this concern applies broadly across various neurodivergent children.  This often leads to the entire family suffering from chronic sleep deprivation with a knock-on effect on family functioning, including employment and the ability of the child and their siblings to learn.  Too often families assume that there is no way to avoid this, that it is an unavoidable aspect of their child’s diagnosis. However, this is not the case, especially if the family can learn positive techniques when the child is still young.  

This presentation includes:

• An introduction to the architecture of sleep and how it differs in the neurodiverse community. This includes a discussion of the reasons why autistic children and other neurodiverse individuals may be more likely to experience sleep difficulties. Understanding the underlying mechanism of sleep ensures a treatment plan that is realistic and addresses key problem areas.
• A review of basic sleep problems (e.g., early waking, insomnia) and how analyzing the child’s behavior can support families to achieve healthy sleep with a positive, pro-active approach. Identifying the “why” behind a sleep problem is the foundation to developing a successful sleep plan. Every sleep plan should be individualized to a family’s cultural needs, current capacity and desired outcomes.
• Through case studies, the process of assessment, plan development and support implementation will be described. 
• A discussion of tangible takeaways to support healthy sleep for adults and children will be a major part of this presentation. Sleep is the foundation to overall health. Healthy sleep habits starting from the moment you wake up!

 

About the Presenters

Hilary McClinton, M. Ed., BCBA

Hilary McClinton has a Master’s in Special Education from the University of British Columbia and is a Board Certified Behavior Analyst. She lives in Maple Ridge, British Columbia and has supported the neurodivergent community for over 20 years, including supervision and mentorship of other practitioners in the behavior analytic community.  

Hilary began specializing in sleep when she experienced sleep deprivation as a new parent and wanted to help other families find healthy sleep. For Hilary, creating a family-centered model of support has been a key piece to ensuring sleep plans are based on parent values and cultural considerations.  

Nicole Shallow., M.Ed., BCBA

Nicole Shallow has a Master’s in Special Education from the University of British Columbia and is a Board Certified Behavior Analyst. Nicole lives in Langley, British Columbia and has supported the neurodivergent community since 2012 in a variety of roles. Nicole’s commitment to helping others achieve better sleep comes from her own personal experience with sleep challenges. For Nicole, sleep support is built on the foundation of trust, transparency and collaboration.  

Both Hilary McClinton and Nicole Shallow work through Coastal Ridge Consulting, based in the Fraser Valley, and recognize the unceded territory of the Katzie and Kwantlen First Nations.

Part 2: How we view sleep/Assessments

Part 3: Case Study 1: Toddler

Part 4: Case Study 2: Adolescent

Part 5: Case Study 3: Preschooler

Part 6: Case Study 4: A mix of everything

Part 7: Q and A

Use the chapters menu on the bottom right of the video to see the list of questions.

Filmed November 2021 – edited into 10 parts; total 170 minutes

Download the presentation handout (71 pages)

Many children and adolescents with autism and other neurodiverse conditions present significant concerns to carers who are trying to ensure proper levels of nutrition. This presentation begins with a discussion of selective eating and the factors that can affect a child’s eating. Our presenters then discuss how food preferences develop and the importance of children tasting a wide range of foods.

Step by step strategies for expanding a child’s diet are included, such as ways to increase the likelihood your child will take a bite, and how to respond when your child is refusing.

The presenters provide answers to questions commonly asked by parents during therapy, including:  

• “What if I’ve tried rewards but my child still won’t take a bite?”
• “Will my child always rely on rewards to eat new healthy foods?”
• “What if it never gets easier to feed my child?”
• “When do I honour my child’s dislike for a new food?”
• “What if my child is sensitive to textures?”

About the Presenters

Lauren Binnendyk, PhD, BCBA-D

Lauren Binnendyk has a PhD in Special Education (concentration in autism and related disabilities) and is a Board Certified Behavior Analyst (BCBA-D) and has worked with children with developmental disabilities since 1997. Dr. Binnendyk is the Clinical Director at West Coast Feeding and Behaviour Specialists which she opened in 2010 to provide families with evidenced-based, family centred treatment of severe feeding disorders. Her practice has expanded to include a range of feeding concerns including, picky eating, bottle or milk dependence, chewing issues, and Avoidant/Restrictive Food Intake Disorder (ARFID).

Chantal Juilfs, M.Ed. BCBA, Behavior Analyst Consultant

Chantal received her Master’s degree in Special Education (concentration in developmental disabilities) from the University of British Columbia in 2017 and is a Board Certified Behaviour Analyst. In 2013, Chantal began specializing in feeding disorders under the supervision of Dr. Binnendyk at West Coast Feeding and Behaviour Specialists. Chantal has focussed her practice on working with individuals diagnosed with Avoidant Restrictive Food Intake Disorder, food selectivity, food refusal, and oral motor delays. Chantal understands the underlying fear involved with trying new foods for most of the individuals she works with and uses evidenced-based strategies to help them work through their fears to reach their goals.

Part 1: Introduction

Part 2: Avoidance Restrictive Food Intake Disorder (ARFID)

Part 3: How do I Expand my Child’s Diet? – Taste Exposures

Part 4: Antecedent Strategies

Part 5: Consequence Strategies

Part 6: Case Study #1: A 5-Year-Old with Selectivity & Rigidity Feeding Issues

• 5 years old at the start of intervention
• Lives with his parents – with grandparents from after school until dinner time
• Diagnosed with ASD
• Feeding Issue: Selectivity, rigidity
• Mealtimes: EL had a typical eating routine until he went with his dad to visit family in another province for a week. EL started to drop foods quickly until he had 4 in each food group, and many foods that were “hit/miss” and started only eating a few bites of the foods on his accepted food list.

Part 7: Case Study #2: A 20-Month-Old with Anemia & Selective Feeding Issues

• 20 months old at the start of intervention
• Lives at home with her parents
• Background:
  • Born with a heart defect and underwent surgery after birth
  • Diagnosis of ASD
• Feeding issues:
  • Has always been a picky eater
  • History of eating a food for 1‐2 weeks and then dropping it.
  • Anemic
• Mealtimes:
  • Sits in a high chair or stands on a learning tower
  • Eats completely distracted
  • Breastfed throughout the day

Part 8: Case Study #3: A 3-Year-Old with Oral Motor Delays & Selectivity Feeding Issues

• 3 years old at the start of intervention
• Lives with his parents and two younger brothers
• Diagnosed with ASD
• Feeding Issue: Oral Motor Delays & Selectivity
  • Round 1: Purees
  • Round 2: Chewing Intervention
  • Round 3: Variety, Speed, and Chewing
• Mealtimes: Ate mealtimes with family, but highly selective with new foods. If he accepted bites of non‐preferred foods, he would pack them in his cheek pocket for hours.

Part 9: Before You Start Tasting Sessions/Common Mistakes and Questions

Part 10: Q and A

Use the chapters menu on the bottom right of the video to see the list of questions.

Pat Mirenda, PhD, BCBA-D – University of British Columbia

Katie Rinald, PhD, BCBA – Blackbird Toileting Services

Filmed February 2021 – edited into 29 parts; total 432 minutes

Tackling toilet training successfully is crucial for a person to be fully included in the community. In this edited version of a two-day workshop, Professor Pat Mirenda and Katie Rinald return for an updated version of their 2014 presentation which has been ACT’s most popular online presentation.

Show more

Presentation Handouts

• Presentation Handouts – Day 1
• Presentation Handouts – Day 2
• Long Way Baseline Data Sheet
• Long Way Intervention Data Sheet
• Rapid Toilet Training Data Sheet
• Toilet Training References 2021
• Use Guided Access with iPhone, iPad, and iPod touch
• Use of urine alarms in toilet training children with intellectual and developmental disabilities: A review

Part 1: Introduction

Topics Covered:

• Myths about toilet training
• Overview of toilet training methods: Rapid Toilet Training and The Long Way

Part 2: Getting Ready

Topics Covered:

• Preparing yourself
• Clothes and getting rid of diapers or pull-ups
• Seating

Additional links and resources

• mylilmiracle.com

Part 3: Importance of Reinforcers

Topics Covered:

• Identifying reinforcers
• Examples of outside-of-the-box reinforcers

Part 4: Bowel Training

Topics Covered:

• Considering medical issues
• Diet
• Other considerations: clothing, seating and reinforcement

Part 5: Introduction to Rapid Toilet Training (RTT)

Topics Covered:

• Background of RTT
• RTT disclaimer
• Is this trainee a good candidate for RTT?

Part 6: Getting ready for RTT

Topics Covered:

• Items needed for RTT
• Setting up
• What does RTT teach?
• Four key components
  • Increased fluids
  • Scheduled toilet sittings
  • reinforcement for correct toileting
  • Redirection for accidents

Part 7: Increased Fluids

Topics Covered:

• Do’s and Dont’s for increased fluids
• Examples of fluids

Part 8: Scheduled Toilet Sittings

Topics Covered:

• On and off toilet phases
• Using reinforcement
• Do’s and Dont’s for scheduled toilet sittings

Part 9: Scheduled Toilet Sitting Example

Topics Covered:

• How to record data
• What to do if there are accidents

Part 10: Reinforcement for Correct Toileting

Topics Covered:

• Purpose of reinforcement
• How to know if the reinforcement is working
• Examples of reinforcement
• Do’s and Dont’s for reinforcement

Part 11: Redirection for Accidents

Topics Covered:

• What to do if an accident occurs
• Do’s and Dont’s for redirection

Part 12: RTT Wrap-up

Topics Covered:

• Planning for intitation
• What’s next?

Part 13: RTT Dilemma

Topics Covered:

• Covering common questions and problems with RTT

The Long Way

Part 14: Urination Trip Training Part 1

Topics Covered:

• Urination “Trip Training” introduction
• Calculating how often to take the person to the toilet

Part 15: Urination Trip Training Part 2

Topics Covered:

• Communicating it’s time to pee
• Providing reinforcers
• What to do if an accident happens
• Filling out the data sheet

Part 16: Urination Self-Initiation

Topics Covered:

• Self-initiation and communication
• Identifying signals
• Gradually increasing trip intervals to prompt self-initation
• Fading reinforcers

Part 17: Bowel Movement Trip Training

Topics Covered:

• Figuring out when to take the person to the toilet
• Recording bowel movement times

Part 18: Bowel Movement Self-Initiation

Topics Covered:

• Self-initiation and communication
• Identifying signals
• Gradually increasing trip intervals to prompt self-initation
• Fading reinforcers

Part 19: Getting ready for Night Time Training

Topics Covered:

• Bed Wetting
• Consider medical issues
• Why you may want to wait to do nighttime training

Additional links and resources

• Items needed: chummiebedwettingalarm.com

Part 20: Night Time Urination Training

Topics Covered:

• What to do if the trainee has already peed by the time you’ve come to help
• What to do if the trainee hasn’t peed

Part 21: Night Time Bowel Training

Topics Covered:

• Could it be a problem behaviour issue?
• Talking to a doctor

Part 22: Case Study 1: The Dribbler

Part 23: Case Study 2: The Reluctant Pooper

Part 24: Case Study 3: The Quiet Pee-er

Part 25: Home-School Disconnect

Topics Covered:

• Different rules for home and school
• Instituting similar training programs at home and school
• Break time dilemma

Part 26: iPad Dilemma

Topics Covered:

• Using the iPad as a reinforcer and possible scenarios

Part 27: Tiny Poop/Constipation Dilemma

Topics Covered:

• Dealing with constipation
• D3 Cycle: discomfort-dread-delay
• A multidisciplinary plan to break the cycle

Q & A Part 1: Rapid Toilet Training

00:00 – Any tips for blind and deaf kids?

01:06 – What if there is no success?

01:29 – What counts as a rewardable pee in the toilet?

05:43 – Are there good names we should use for the reinforcers?

6:05 – Do we teach hand washing and flushing during Rapid Toilet Training?

6:33 – What if the child shows unwilling or aggressive behaviour?

6:59 – What if the trainee has an accident during the two-minute break?

7:16 – Is the trainee accessing the reinforcement for the entire break time?

10:33 – What happens if they tantrum when they have to stay in the bathroom?

10:47 – What are your suggestions for kids who hold pee too long? Bladder infections?

12:42 – Can you use RTT for a shorter number of hours?

15:17 – Is RTT done for the time the child wakes to the time the child goes to bed?

15:49 – What if the trainee stops peeing due to excitement?

16:19 – Would you offer different reinforcements and let them choose out of choices?

17:50 – What happens if the child requests for an item that’s not available?

19:06 – Does rapid training work for trainers who are already pee trained?

19:33 – Underwear inside pull-ups?

21:29 – This child let’s me know after they potty but not the she needs to ago, how do we address this?

22:07 – What do you think about ice cream for increasing fluid?

22:32 – I have a child who can go to the potty daily for a week at my parents, but won’t use it at home.

24:12 – When we provide activities during toilet sitting times, will that divert them from peeing or pooing?

24:54 – If you have a child who can go away for a week with no accidents but then comes home and has non-stop accidents, is this behavioural or is this child purposefully doing this?

25:51 – How do I get the child to make the toilet sign?

28:27 – Have hemorrhoids been an issue?

29:00 – Why have you removed the chair (prompting for self-initiations) from your RTT procedures?

31:57 – Should they not be in clothes during breaks?

32:31 – If it starts as an accident but they finish on the toilet, is that considered a success?

32:57 – Same amount of liquids for all of the phases?

33:29 – Can you comment on how this can work with kids with physical disabilities?

33:49 – Does the kid wear underwear during the five-minute break?

33:55 – How long does the trainee get with their reinforcement?

35:41 – How many hours in a day do we do this?

36:02 – Is the reinforcement interval the same as the break off the toilet?

36:28 – How do you treat bowel movement accidents during pee training?

37:00 – Should the child be naked? How can you see the accident on time otherwise?

37:55 – If I start RTT and it’s not working, how do I transition to The Long Way?

39:46 – Can you please clarify if there is a scheduled break after an accident off the toilet versus an accident that finishes on the toilet?

Q & A Part 2: The Long Way

00:00 – Is it possible kids might get distracted from pee and poo from the activities they are doing on the toilet?

1:03 – When you’re looking for the sweet spot, why don’t you round down?

2:05 – After mealtimes, my child may need to pee sooner than the average length of time, what should we do?

3:09 – How does the schedule depend from liquid consumption events?

4:27 – What about trainees who are resistant of the toilet from past training?

8:13 – Can we bring fun activities into the bathroom to help trainees stay on the toilet for long method trip training?

8:46 – How do you respond if they only partially empty?

9:31 – Can you use a visual schedule to remind them?

9:44 – What if the child is wet when you take them to sit but they also pee in the toilet?

10:13 – If you’re on a one hour and forty-five minute schedule and they initiate pee at one hour, do you wait another hour and forty-five minute to take them again or do you stay on your original schedule?

11:17 – When cleaning up after an accident, what can you say so they understand?

11:49 – If the trainee, who has no speech and AAC, already has initiation to pee into the toilet but has accidents occasionally, should the communication piece be introduced in the procedure?

13:15 – what if the learner says no and refuses when asked to go to the bathroom?

16:04 – Do you always need a tangible reinforcement in addition to praise?

16:43 – Are there alternatives for the bed wetting alarm?

18:38 – Have you ever used the wearable alarm during rapid toilet training and what were the outcomes?

21:05 – Which of the two methods are most effective?

22:04 – Would it be considered a punishment for not having a reinforcement in the morning if they wet the bed at night?

23:15 – Does the trainee get reinforcement if they trigger the alarm but finish in the toilet?

24:18 – I know my son has to go at five in the morning so I wake him up and prompt him to go, do we still need a wet bed alarm?

25:38 – What if they continue dribbling even during rapid toilet training?

27:25 – During the data collection phase, do you bring the trainee to the bathroom?

28:21 – If we’ve already started trip training, can we take baseline data from where the child is presently?

28:50 – Any suggestions for a child who hides in a closet to poop in his underwear?

29:45 – How can a non-verbal and non-pointing trainee do the self-initiation or tell me how they want to pee or poo.

30:55 – Trainee only has accidents on days when they are on their period?

32:57 – When fading the diaper for a reluctant pooper, could you empty the diaper into the toilet to show them where it should go?

33:22 – What about trainees who are not currently squatting to poop?

33:44 – Suggestions for a child who waits until nap time to poo in the diaper?

36:25 – How much water would you recommend for a 6 – 12 year old?

37:28 – How long should training sessions be during the Long Way?

38:19 – With respect to leaving the trainee in their clothing until the next interval, can you speak in detail as to how to to address caregivers who express concerns about dignity?

41:32 – Accidents at school?

45:17 – Once the bed pad gets wet, can it be used again in the same night?

45:31 – What about trainee’s who touch themselves a lot?