Autism spectrum disorder is a neurodevelopmental disorder that is persistent into adulthood and is characterized as persistent impairment in reciprocal social communication and interaction and restricted repetitive patterns of behavior, interests, and activities. The symptoms are already present in early childhood and have a limiting effect on the child’s everyday functioning. As a result, people with autism spectrum disorder have difficulty adopting adaptive behavior that allow us to act effectively and in line with social expectations in various areas of everyday life. One of these areas is also self-care, which includes independent use of the toilet. The latter has a positive effect on an individual's quality of life, as it enables them social inclusion and an appropriate level of hygiene maintenance. Children learn to use the toilet independently in the process of toilet training, while individuals with developmental disorders (including autism spectrum disorder) are late in development compared to their peers with typical development, which means that they also later learn to use the toilet independently. In the process of toilet training, autism spectrum deficits are most often manifested in the areas of communication, sensory processing, routines, generalization of knowledge and motor skills, and hinder the child from learning to use the toilet independently. Considering the characteristics of the disorder, experts have developed approaches to toilet training that are more adapted to children with developmental disorders, thus making it easier for them to learn to use the toilet independently.
The master's thesis presents a case study covering an example of a behavioral approach to toilet training using positive reinforcement combined with structured learning based on the introduction of visual aids for a three-and-a-half-year-old child with autism spectrum disorder. The thesis includes the definition of prerequisites for starting toilet training, planning toilet training, implementation of toilet training by parents and evaluation of the impact of toilet training on the level of independence of the child in using the toilet. The research represents a model and starting point for planning individualized toilet training for other children with autism spectrum disorder, which can help professionals from the special education field and parents of children with autism spectrum disorder.
The toilet training performed as part of our research contributed to a higher level of independence of the involved child with autism spectrum disorder when using the toilet. After the end of training, the child no longer used diapers while they were at home with the family. He still used them in kindergarten and in other environments outside the home as well as at night. The need to use the toilet, which he had not previously communicated, was communicated at the end of training by exchanging pictures. When undressing and dressing, he needed full physical support before the start of training, and only partial physical support at the end. We also observed an increase in nonverbal behavior by which the child indicated that he was aware of the need to use the toilet. In the eight weeks of training, the child made progress in all areas of training in which we set goals.
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