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?

Brenda Fossett, PhD, BCBA-D, Capilano University

Filmed November 2020 – edited into 14 parts; total 213 minutes

Parents often assume that the difficulties they face in helping their children develop healthy daily routines are a part of their child’s autism and must be endured. This presentation provides parents and caregivers an overview of Positive Behavior Support (PBS) with the goal of supporting them to be proactive in helping neurodiverse children to be safely included in home, school and community activities. Core features of PBS include the application of behavioral science (ABA), the use of practical strategies to promote desired behavior, and a focus on improving the quality of life for the individual and their family. 

A goal of this presentation is to increase parental awareness of good PBS service, so they can find a behavior consultant to support them in using positive strategies to address essential functional skills, including toileting, sleep and mealtimes. Importantly, parents will learn about positive strategies they can begin using immediately with young children to lessen the child’s reliance on destructive or self-injurious behaviors to communicate their distress. Parents of older children will better understand the challenges their children are experiencing  and how to identify skilled support to provide the young person with positive ways of having their needs met while being fully included in their community. 

Learning Outcomes

At the end of this workshop, participants will be able to:

• Define Positive Behavior Support
• Identify common misconceptions regarding PBS
• Identify common purposes served by problem behavior
• Identify components of a quality PBS-based intervention
• Describe common preventative strategies

Presentation Handout (40 Pages)

Presenter Bio

Brenda Fossett is an inspired teacher who is widely admired for her ability to convey complex concepts to those who work with children and adults with diverse needs, whether they are educational professionals or parents.  Dr. Fossett has been on faculty in the Applied Behavior Analysis – Autism Department at Capilano University since 2013. She is a certified teacher of the deaf and a Board Certified Behavior Analyst. Dr. Fossett has extensive clinical experience providing behavioral and educational consultative services to children with ASD, deafness, and other developmental conditions in home, school, and community settings. Her scholarly and clinical interests include: applied behavior analysis, the implementation of positive behavior support in home and school settings, and educational interventions for deaf children with developmental disabilities. 

Part 1: Positive Behavior Support Introduction

Topics Covered: 

• Traditional vs. current views on behaviour
• Application of behavioral science
• PBS process

Part 2: Functional Behavior Assessment

Topics Covered: 

• Identifying problem behaviors
• Four functions of behaviour

Part 3: Indirect Assessment

Topics Covered: 

• Gaining information from relevant sources
• Identifying physical and environmental factors that influence behaviors
• Identifying functions of behaviors

Part 4: Direct Assessment and Functional Analysis

Topics Covered: 

• How to gather evidence to support hypotheses regarding problem behavior
• What information direct observation should provide
• When functional analysis is needed

Part 5: Designing PBS Plans and Setting Events

Topics Covered: 

• Identifying setting events and possible strategies
• Preventing setting events from occurring
• Reducing impact of setting events

Part 6: Antecedent Strategies

Topics Covered: 

• Increase cues for appropriate behaviors
• Decrease cues for problem behaviors

Part 7: Teaching Strategies

Topics Covered: 

• How to pick teaching strategies based on context, challenges and goals.
• Functional Communication Training (FCT)

Part 8: Consequence Strategies

Topics Covered: 

• How to increase desired behaviors
• How to increase alternative replacement behaviors

Part 9: PBS Example: Transition to Bath Time

References video shown in Part 4.

Topics Covered: 

• Breaking down an example of PBS

Part 10: Accessing PBS Services

Topics Covered: 

• What to look for in a PBS service
• Behavioral parent training
• Data collection systems

Part 11: Introduction to Visual Support Strategies to Prevent Problem Behavior

Topics Covered: 

• Challenges in processing speech or sign language
• Predictability and ease transitions
• Understanding expectations

Part 12: Visual Support Strategies

Topics Covered: 

• Environmental supports
• Visual schedules
• Object cue schedules
• Within activity schedules

Part 13: Visual Support Strategies Continued

Topics Covered: 

• Rule supports
• ‘Universal No’ symbol
• Choice Boards
• Waiting Supports

Part 14: Putting it All Together

Topics Covered: 

• Collaborative Partnerships
• Parents’ roles

Visual support strategies have been used to successfully support children, youth and adults with autism and other developmental disabilities for decades. Many are familiar with the use of visual schedules, but there are many ways in which visual support strategies can be used. These supports have been demonstrated to increase independent functioning, teach specific skills, improve environmental awareness, teach rules and social expectations, reduce problem behavior and so much more! There is a large body of research to support the use of these strategies with children, youth, and adults in home, school, community and employment settings.

Filmed at Picturing Success: Visual Support Strategies for Individuals with ASD – October 20-21, 2017

Download supplementary slides for this presentation

Brenda Fossett, PhD, BCBA-D, Capilano University

Dr. Brenda Fossett, BCBA-D, is an inspired teacher who is widely admired for her ability to convey complex concepts to those who work with children and adults with diverse needs, whether they are educational professionals or parent. Dr. Fossett has been on faculty in the Applied Behavior Analysis – Autism Department at Capilano University since 2013. Prior to that she was Assistant Professor (Special Education) in the Department of Educational Psychology at the University of Alberta. She is also a certified teacher of the deaf, as well as being a Board Certified Behavior Analyst.

Dr. Fossett has extensive clinical experience providing behavioral/educational consultative services to children with ASD, deafness, and other developmental disabilities in home, school, and community settings. Her scholarly and clinical interests include: applied behavior analysis, the implementation of positive behavior support in home and school settings, and educational interventions for deaf children with developmental disabilities. For more information on Dr. Fossett see www.capilanou.ca/abaa/diploma-post-bac/Faculty/.

 

---

Introduction to Visual Support Strategies

Part 1: Overview of Visual Support Strategies

Part 2: What Does the Evidence Say?

• Object cues
• Difference between graphics symbols and PECS
• Selecting appropriate representations

---

Symbol Assessment Preparation, Formats, and Planning

Part 1: Symbol Assessment

• Preparing for a symbol assessment

Part 2: Symbol Assessment Formats

• Receptive Language Format
• Yes/No Format
• Visual Matching Format
• Conducting a symbol assessment

Part 3: Planning for the Future

• Other considerations

Part 4: Where to Get Symbols, Photographs, and Materials

---

Visual Supports Guide

Part 1: Visual Supports to Provide Information

• Environmental supports

Part 2: Visual Schedules

 

Part 3: Using an Object Cue Schedule

Part 4: Using Visual Schedules

• Embedding behavior support in visual schedules
• Time pieces in a visual schedule

Part 5: Using Visual Schedules (continued)

• Tablet-based visual schedules
• Teaching with a visual schedule
• Considerations when using visual schedules

Part 6: Visual Schedule Routines – with examples

• Within-activity visual schedules
• Examples include: Showering, After-school Routine, Transition Routine: School to Homework, Snack Routine at School, Dressing at the Pool, Making a Sandwich, Using the Bus, and Morning Routine
• Table-based within-activity schedules using Pictello

Part 7: Creating and Using Within-Activity Schedules

• Temporal and waiting supports in a visual schedule
• Using timers and track timers

Part 8: The Problem with Social Interactions and How Visual Supports Can Help

• Social narratives: Social Stories, Power Cards, Tablet-based social narratives
• Implementing social narratives

Part 9: Using Contingency Maps

Contingency maps are a visual support designed to provide information regarding the consequences for positive and problematic behavior.

Part 10: Rule Supports

Rule supports are a visual depiction of the rules. They can provide information regarding rules and assist with teaching individuals to follow rules.

---

Improving Communication with AAC

Part 1: Augmentative & Alternative Communication (AAC)

• Supporting expressive communication with AAC

Part 2: Expressive Communication using Choice Making

• Visual support strategies for choice making
• Using choice boards

Part 3: Improving Expressive Communications: Communication Boards & Books

Part 4: Improving Communication Using the Picture Exchange Communications System (PECS)

• Overview of PECS
• When PECS is appropriate
• Six phases of PECS instruction

Part 5: PECS in Daily Activities

• Examples of implementation
  • At a restaurant
  • During cooking
• Exchange-based communication support

---

Improving Conversation Skills

Part 1: Visual Support Strategies to Improve Conversation

• Conversation supports
  • Visual bridges
  • Conversation books
• Examples of visual bridges

Part 2: Improving Conversation Skills with Conversation Books

• Creating conversation books
• Teaching conversation book use
• Tablet-based conversation books
• Developing communication skills

---

Improving Skill Acquisition

Part 1: Improving Skill Acquisition with Video Modelling

• Definition: Video of a model demonstrating desired behavior
• Different types of video modelling
  • Video modeling
  • Video self-modeling
  • Point-of-view video modeling
  • Video prompting
• What can we teach with video modelling?

Part 2: Implementing Video Modelling

• Planning a video model
• Making the video
• Showing the video
• Apps for video modelling

---

Improving Literacy Skills

Part 1: Academic Activities & Literacy

• Access to academic activities
• Instruction guides
• Examples of lesson topics
  • The periodic table
  • Transportation in Canada
• Story guides: Examples with Tale of a Fourth Grade Nothing, Owls in the Family, Chocolate Fever, and Charlotte’s Web

Part 2: Adapted Stories for Read-Alouds

Add visual supports and adapted text to storybooks to improve access during read-alouds.

• Adapted story example: Caillou: Merry Christmas!
• Adapting story books and novels
• Question and answer activities
• Brainstorming for poem writing
• Lesson on healthy eating
• Graphic organizers
• Sort & classify
• Compare & contrast

Part 3: Graphic Organizers for Sequencing & Describing

• Examples of sequencing: Romeo & Juliet, The Little Red Hen, The Rainbow Fish, Turtle Hatching, The Mitten
• Examples of describing: The Rainbow Fish, Jack and the Beanstalk, Charlotte’s Web

Part 4: Visual Supports for Literacy Development

• Skills for literacy development
• Teaching comprehension of text
  • Drawing to show comprehension
• Visual supports for writing

---

Considerations and Planning for Visual Supports

• Considering your purpose
  • Determine the necessary representation and type of visual support needed
  • Determine what type of visual support is most appropriate
• Creating your visual supports
• Advice for implementing & using visual support strategies in practice

---

Resources recommended by Dr. Fossett

• Indiana Resource Center for Autism

•  The Center on the Social and Emotional Foundations for Early Learning, Vanderbilt University

• VCU Autism Center for Excellence

  Virginia Commonwealth University Autism Center for Excellence provides a number of online resources, including 45-minute webcasts, 30-minute seminars, and 5 minute ‘how to’ videos demonstrating a number of evidence-based interventions, including the use of visual supports. This website also provides guides and factsheets related to evidence-based interventions.

• Design to Learn

  Provides information and resources focused on early communication development, including the use of tangible symbols, with an emphasis on individuals with complex communication needs/dual-sensory impairments/etc.

• In the references/resources section of the handouts, there are links to two providers of online modules (Autism Internet Modules and AFIRM). There are also links for Mayer-Johnson (Boardmaker) and SymbolStix, as sources for symbols. The best place to buy Boardmaker in Canada is Bridges (prices in Canadian dollars and shipping from Canada).