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.

Two parents were concerned because their two young girls were delayed in learning to use the potty. In this study we obtained data on the frequency of wet diapers and use of the potty at home. Following baseline, an intervention was implemented that involved increased intake of liquids and salty foods, prompting, and positive reinforcement. Once a substantial decrease in wet diapers was achieved, together with an increase in use of the potty, the girls were offered the opportunity to wear "Princess Underwear!" as an even more powerful prompt and reinforcer. An ABC design was used with each girl. The results showed significant increases in their use of the potty and decreased incidents of wet diapers when the intervention was in effect. Although this design does not rule out possible effects of coincidences, the data are consistent with the hypothesis that the intervention produced improvements in potty training.

OBJECTIVE Toilet training (TT) is important for every child, but there is no agreement on what is the best training method. We evaluated in a randomized way the comprehensive use of a daytime wetting alarm at home for 5 days in healthy children and compared it with timed potty training. METHODS Thirty-nine children, between 20 and 36 months of age, were randomized to wetting alarm diaper training (WAD-T; n = 20) or timed potty training (TP-T; n = 19). Toilet behavior was observed by parents and independent observers before, at the end, and after 2 weeks of training. Late evaluation at 1 month was done by telephone. RESULTS The WAD-T group did significantly better than the TP-T group at the end training (p =.041), at 14 days (p =.027), and 1 month after training (p =.027). Independent bladder control was achieved in 88.9% of the WAD-T group. CONCLUSIONS The WAD-T method is a structured, child-friendly, highly effective option for TT young healthy children. It offers the parents clear guidelines, a limited time needed to complete TT, a high success rate, and minor emotional conflicts. Results must now be confirmed in a larger sample size.

AIMS To review the literature on toilet training (TT) in healthy children. METHODS Through an extended literature search, all data on developmental signs of readiness for TT, TT methods, definitions of being toilet trained, TT problems, and predictive factors for success were reviewed. RESULTS Specific studies on this topic are few. Two main methods for TT have been described so far in the last decades: the gradual child-oriented training and the structured, endpoint-oriented training. In the former method parents mainly respond to the child's signals of toileting "readiness". The latter method consists of actively teaching several independent toileting behaviors. Data are too few to be able to compare the methods. Literature does not give a consensus about the optimal age for starting nor on the expected mean age of completing TT. Recent studies show most children to start training between 24 and 36 months of age with a current trend toward a later completion than in previous generations. The consequence of this can be stress for the parents and more use of diapers, with its negative effect on the environment. CONCLUSION There are as yet little data to be found on this important topic, only few studies have been published in peer-reviewed journals. Standardization of terminology and critical evaluation of the described techniques in large sample sizes is needed. With this approach, general principles of training, evidence based and easy to use in the majority of children, may become available to parents.

There is a growing trend toward later toilet training of typically developing children. This trend is a problem for caregivers and professionals who work with young children, because it is associated with a number of costs and health risks in child-care settings. Results of a recent study (Tarbox, Williams,& Friman, 2004) suggest that wearing underwear may facilitate the development of toileting skills. Based on these findings, we examined the effects of wearing disposable diapers, disposable pull-on training pants, and underwear on urinary continence of 5 typically developing toddlers in a child-care setting. Underwear decreased incontinence and increased continent urinations for 2 of the 5 participants, produced no improvement in 2 participants, and when combined with increased fluid intake and longer sitting periods, produced some favorable trends for the 5th participant.

Branch and Vollmer (2004) argue that use of the word behavior as a count noun is ungrammatical and, worse, mischaracterizes and ultimately degrades the concept of the operant. In this paper I argue that use of behavior as a count noun is a reflection of its grammatical status as a hybrid of count and mass noun. I show that such usage is widespread across colloquial, referential, and scientific documents including the writings of major figures in behavior analysis (most notably B. F. Skinner), books describing its applications, and its major journals. Finally, I argue against the assertion that such usage degrades the concept of the operant, at least in any meaningful way, and argue instead that employing eccentric definitions for ordinary words and using arcane terms to describe everyday human behavior risks diminishing the influence of behavior analysis on human affairs.

The effectiveness of a multi-component computer based training package that consisted of competency based instructions, video modeling, and two forms of feedback was evaluated in terms of treatment integrity of two procedures across four staff. Treatment integrity in completing critical steps of discrete-trial and backward chaining procedures were measured using a multiple baseline design across participants, counterbalanced for procedures. All four participants reached 100% treatment integrity on at least one skill in a role play setting. Maintenance probes showed skills maintained at the same levels 6 weeks following training.

OBJECTIVE To evaluate the Bedtime Pass Program (BPP), an extinction-based procedure for treating bedtime resistance in typically developing children. METHODS A randomized, controlled trial in which nineteen 3- to 6-year-old children demonstrating bedtime resistance were randomly assigned to a Bedtime Pass or Monitoring Control group. The experimental condition involved parent monitoring plus the Bedtime Pass: a card exchangeable for one parental visit or excused departure from the room after bedtime, with parents ignoring subsequent bids for attention. RESULTS Children in the Bedtime Pass condition left their rooms and called and cried out significantly less frequently than controls. They demonstrated significant reductions in the time required to quiet each night. Treatment effects were maintained at 3-month follow-up. Parents reported high levels of satisfaction and treatment acceptability. CONCLUSIONS BPP is a noncomplex, socially acceptable, effective treatment for bedtime resistance. It retains the powerful effects of extinction-based procedures without the "extinction burst."

The present study examined the use of an instructional workshop for training educators to conduct functional analyses. Results indicated that 2 of 3 participants met the accuracy criterion following group training, whereas 1 participant required direct verbal feedback. During generalization probes, one participant accurately conducted sessions with a student in her classroom.

Out-of-home treatment for youth with conduct problems is increasing rapidly in this country. Most programs for these youth deliver treatment in a group format and commonly employ some version of a token economy. Despite widespread evidence of effectiveness, a substantial minority of treated youth fail to respond. Participants for this study were 3 youth who were nonresponsive to treatment provided in a family-style residential care program with a comprehensive token economy. Our approach to the "nonresponse" of these youth involved modifications of the frequency and immediacy of their access to the backup rewards earned with tokens. We evaluated the effects of the modifications with a treatment-withdrawal experimental design. Dependent measures included two indices of youth response to treatment: intense behavioral episodes and backup rewards earned. Results showed substantial improvement among these indices during treatment conditions.

The purpose of this study was to assess the concurrent criterion validity of the attention-deficit/hyperactivity disorder (ADHD) portion of the National Institute of Mental Health Diagnostic Interview Schedule for Children-IV (NIMHDISC-IV). Fifty-seven adolescent participants were divided into three groups on the basis of whether participants met criteria for ADHD on caretaker and adolescent responses on the DISC:(a) 18 participants for whom both the caretakers and adolescents endorsed ADHD,(b) 17 participants for whom the caretakers but not the youth endorsed ADHD, and (c) a clinical control group with no ADHD diagnosis (n = 22). These three groups were compared across parent, teacher, and adolescent checklists; clinician diagnosis; and three objective measures of behavior (continuous performance task, actigraphy monitoring, and a structured observation). Findings lend partial support to the concurrent criterion validity of the ADHD section of DISC.

Little research has been published on tattling, even less on its social impact, and we found none directly investigating tattling by adolescents. This study assessed the extent to which tattling, as perceived by peers and caregivers of adolescents in a residential care program, was associated with various dimensions of social status and other behavioral correlates. Eighty-eight adolescent participants rated their housemates on likeability, perceived rates of tattling, and other behavioral descriptors. In addition, caretakers also rated each youth in terms of perceived tattling. On the basis of likeability ratings, participants were classified into one of five categories: popular, average, controversial, neglected, and rejected. Results showed a significant negative correlation between likeability and perceived tattling rates. In addition, youth classified as socially rejected were more likely to be perceived by both their peers and care providers as engaging in high rates of tattling.

Simplified regulated breathing (SRB) has been demonstrated to reduce or eliminate stuttering in children. However, much of the current research has evaluated the intervention with school-aged children within educational contexts. In the current case report, we extended the application of SRB by evaluating its effectiveness in treating stuttering displayed by a 15-year-old resident of a large midwestern residential facility. Further, we evaluated the impact across different assessment conditions. Results showed that SRB resulted in decreased stuttering for the participant, although differential effectiveness across conditions was noted. These results are discussed in terms of the generality of SRB across client populations and clinical settings, as well as the value of addressing contextual variables when treating stuttering.

The Assessment of Basic Learning Abilities (ABLA) comprises six levels of hierarchically ordered visual and auditory-visual discriminations. Scores on the ABLA, Vineland Adaptive Behavior Scales, and the Wechsler Intelligence Scale-Revised were obtained for 30 participants selected using a stratified random sample (i.e., by level of mental retardation) from 499 people served by a state center. Two noteworthy findings were (a) that correlations between the Vineland domains and the ABLA were all significant and ranged between .65 and .73, and (b) no participant performing below ABLA Level 6 was testable on the WAIS-R. Thus, Level 6 can be used as an efficient screen to determine the testability of this population on standardized intelligence tests. Implications for practitioners are discussed.

The authors evaluated the effects of response prevention, a treatment previously shown to be effective for routine thumb sucking and suggested to be effective for early onset trichotillomania, applied to hair pulling in a 2-year-old. Response prevention was used alone in two settings (bedtime and naptime) and combined with a brief time out in another (daytime). The authors also used a novel assessment, weight of hairs pulled, and the results indicated complete cessation of hair pulling. Corresponding photographic evidence indicated complete regrowth of hair lost to pulling. These results add to a growing literature suggesting early onset hair pulling may be more appropriately classified as a benign habit than as trichotillomania.

This study examined the effects of an experimentally derived, peer-delivered reading intervention on the oral reading fluency of a first-grade student who had been referred for poor reading fluency. Same-grade peers were trained to lead the target student through a structured intervention protocol based on the results of a brief experimental analysis. Results indicated that reading improvements were obtained and are discussed in terms of selecting efficient interventions for use by peers.

PURPOSE The purpose of this study is to perform a population-based, very long-term follow-up of adults who had been shunt treated for hydrocephalus in infancy. METHODS The 72 children with hydrocephalus born in 1967-1978 in western Sweden, who had participated in a follow-up at school age, were re-examined at 30-43 years of age. The 29 with mental retardation were described in terms of developmental level and survival, whereas the remaining 43 were invited to take part in a follow-up and 28 accepted. The assessments included a semi-structured interview pertaining to medical issues, academic achievements and social function. RESULTS Six children had died, i.e. a mortality rate of 8%. Mental retardation was present in 29 (40%), severe (IQ <50) in 13 and mild (IQ 50-70) in 16. Four of the 28 (14%) had cerebral palsy and 8 (28%) had other motor problems. Five (18%) had epilepsy and nine (32%) had visual impairments. A total of 20 (71%) reported some kind of health problem. Repeated revisions of the shunt had been performed in 23 (82%). Many worried about their shunt and requested a systematic medical follow-up. Nineteen subjects (68%) lived with a partner and 16 (57%) were parents. The majority had completed secondary school and 9 (32%) had completed university studies, while 18 (64%) worked full time, equal to the general population. CONCLUSION In general, the group of normally gifted individuals with hydrocephalus, who had been shunt treated during infancy, was functioning well as adults and participated in society to the same extent as other people.

In this study were examined leaders' and members' scores on locus of control, sources of motivation, and mental boundaries to predict the quality of leader-member exchanges. 80 elected officials and their 388 direct reports were sampled in a field study. Analysis indicated followers' scores on locus of control, leaders' scores of self-concept internal motivation, leaders' scores on locus of control, and followers' rated goal-internalization motivation were positively related to leader-member exchanges. Implications and directions for research are discussed.

The purpose of this study was to examine the effects of wearing a pressure vest for a young boy with developmental delays. An A-B-A withdrawal design was used to examine the relation between wearing the pressure vest and child behaviors during a preschool art activity. Although the data showed moderate variability, no systematic differences were found in child engagement when the vest was worn and when the vest was not worn and problem behavior increased when the vest was being worn. These results are discussed in the context of the study limitations. Implications for future research are provided.

This study evaluated the effects of individually composed songs on the independent behaviors of two young children with autism during the morning greeting/entry routine into their inclusive classrooms. A music therapist composed a song for each child related to the steps of the morning greeting routine and taught the children's teachers to sing the songs during the routine. The effects were evaluated using a single subject withdrawal design. The results indicate that the songs, with modifications for one child, assisted the children in entering the classroom, greeting the teacher and/or peers and engaging in play. For one child, the number of peers who greeted him was also measured, and increased when the song was used.

To estimate the clinical significance of tobacco withdrawal, this review located six experimental studies that reported Profile of Mood States (POMS) scores after stopping smoking in untreated smokers and compared them with scores in psychiatric outpatients. The pre-cessation POMS Total Mood Disturbance scores (median = 13.6) were similar to adult norms (mean, M = 17.8) but during abstinence (M = 5 days), the scores had increased (M = 27.4) to be similar to that of psychiatric outpatient norms (M = 25.1). These results and others suggest stopping smoking causes clinically significant distress.

This article describes the use of service-learning to promote cultural awareness in a course for prenursing students. A summary of the course design and rationale for service-learning are included. Students reported personal transformations as a result of the service-learning experience with diverse populations. Implications for the use of service-learning across the undergraduate curriculum are discussed.

A cross-sectional study of 437 ambulance officers in a large state of Australia examined the long-term effects of suppressing emotion reactions to exposure to trauma. Results indicate that the use of emotion-suppressing defenses (e.g., withdrawal or acting out) have a highly significant positive relationship with physical and psychological stress symptoms. Alexithymia scores were also positively associated with stress symptoms. In addition, there was a positive association between years of ambulance service and stress symptoms. Implications of the findings are discussed for recovery from exposure to trauma of emergency services personnel and more generally to the experience of survivors of trauma.

OBJECTIVE: To investigate the influence of tamsulosin treatment on the severity of lower urinary tract symptoms (LUTS) and the impact on quality of life (QoL), including daily life activities and mental well being, in real life practice in Spain. METHODS: 2740 LUTS patients aged 45-75 years who visited a urologist office in Spain received tamsulosin 0.4 mg o.d.. At baseline, after 3 months and after 6 months of treatment a questionnaire was completed by the urologist and the patient. The urologist estimated some aspects of the patient's QoL related to his LUTS. The International Prostate Symptom Score (I-PSS) was used to assess the severity of LUTS, while the BPH-Specific Interference with Activities (BSIA) and the Total Mental Health Rate assessed the impact on daily life activities and psychological well being respectively. RESULTS: After 3 months of treatment tamsulosin significantly improved the mean total I-PSS compared to baseline. After 6 months, the mean total I-PSS was reduced by 11.0 points from a baseline score of 20.3 (> 50% reduction). Tamsulosin also significantly improved the mean total BSIA score and the mean Total Mental Health Rate. These observations were confirmed by the urologists' assessment of the patient's condition: an increase of more than 50% of patients with no or mild voiding and filling LUTS and an increase of 45% of patients with no or only a small interference of their LUTS with daily life activities. The withdrawal rate due to adverse reactions was 2.4%. CONCLUSION: This study shows that tamsulosin improves LUTS and their impact on the patient's QoL and daily life activities, in the opinion of both the patients and the urologists.

The dopamine, glutamate and GABA systems are known to mediate the effects of alcohol on the movement disorders, though their exact roles are not clear. Thus, use of alcohol has implications for pathogenesis as well as management of the movement disorders. These implications are discussed citing a patient who had a strong family history of Huntington's disease and in whom movement disorder and behavioral problems were manifest under alcohol use and withdrawal, but not while being abstinent.