Vicky G. Spencer, Ph.D, BCBA-D, LBA
Meghan Ello, M.S., BCBA, LBA
Shenandoah University
This issue of NASET’s Autism Spectrum Disorder series comes from the Fall 2021 edition of the Journal of the American Academy of Special Education Professionals (JAASEP). It was written by Vicky G. Spencer, Ph.D. and Meghan Ello, M.S. from Shenandoah University. Being able to independently and correctly complete a toileting routine is an important developmental milestone for all children, but for children with Autism Spectrum Disorder (ASD), it may be an extremely difficult skill to acquire (Keen et al., 2007). The focus of this review was to examine the effectiveness of the current research on three common interventions including video modeling, the modified intensive toilet training method (MITTM), and parent-delivered toilet training for increasing in-toilet voiding in children with ASD. Nine single-subject design studies were identified from 2009 to 2019. The overall results of the toilet training intervention studies have shown the procedures reviewed to be effective in increasing in-toilet voiding. Future research should focus on replicating and expanding these interventions, but also combining these interventions to see if the effects would produce more positive results for children with ASD and toileting issues.
Abstract
Being able to independently and correctly complete a toileting routine is an important developmental milestone for all children, but for children with Autism Spectrum Disorder (ASD), it may be an extremely difficult skill to acquire (Keen et al., 2007). The focus of this review was to examine the effectiveness of the current research on three common interventions including video modeling, the modified intensive toilet training method (MITTM), and parent-delivered toilet training for increasing in-toilet voiding in children with ASD. Nine single-subject design studies were identified from 2009 to 2019. The overall results of the toilet training intervention studies have shown the procedures reviewed to be effective in increasing in-toilet voiding. Future research should focus on replicating and expanding these interventions, but also combining these interventions to see if the effects would produce more positive results for children with ASD and toileting issues.
Increasing Independent Toileting in Children with Autism Spectrum Disorder and Other Developmental Disabilities: A Systematic Review
Completing a toileting routine is an important daily life skill for all children and is certainly not a new area of research. Appropriate toileting is a vital developmental milestone for children with Autism Spectrum Disorder (ASD) to meet but may be a difficult skill for these children to acquire (Keen et al., 2007). Learning the skill of in-toilet voiding can be a challenging task for children with ASD, because they often have a difficult time identifying the need to go to the bathroom (Cicero & Pfadt, 2002). Because individuals with ASD tend to need more assistance in toilet training, they may require a more rigorous approach to toilet training (Azrin & Foxx, 1971; Duker et al. 2001). Individuals that are not toilet trained may experience a social stigma, personal health challenges, and other life setbacks, due to the absence of these skills (Cicero & Pfadt, 2002). Research has found that lack of toileting skills can often be a burden to parents (Keen et al., 2007).
Lott and Kroeger (2004) stated two fundamental goals in toilet training: to be able to recognize the need to go to the bathroom and to be able to independently complete the toileting behaviors. In 2009, Kroeger and Sorensen-Burnworth completed a review on teaching toileting skills to individuals with developmental disabilities, including children with ASD, and found that the most frequently recommended approaches are based on modified versions of Azrin and Foxx’s (1971) rapid toilet training (RTT) method. The RTT method includes the use of punishment procedures and was often implemented in institutionalized settings. Presently, the use of punishment procedures has been considered unethical (Keen et al., 2007). Therefore, the move from punishment procedures to reinforcement-based procedures dictated the focus and the range of years included in the review. Further, the interventions could be implemented in the participant’s everyday environment.
The purpose of this literature review was to examine the effectiveness of the current research on video modeling; the modified intensive toilet training method (MITTM), also known as Rapid Toilet Training (RTT); and parent-delivered toilet training interventions for increasing in-toilet voiding in children with autism. The research explored throughout this review focused on providing details on the procedures implemented and the results of these three different interventions. The authors chose to identify and analyze the research that had been published since Kroeger’s 2009 critical review on toileting training individuals with autism and other developmental disabilities.
Method
Literature Search Procedures
The following search procedures were used to retrieve relevant studies for the review. A computer-assisted search of four major databases was conducted including EBSCOhost, Google Scholar, Science Direct, and Wiley Online Library from 2009 to 2019. The following descriptors were used: toilet training, modified rapid toilet training, parent-implemented toilet training, video modeling, and autism.
Criteria for Inclusion
Nine studies were identified during the period from 2009-2019 in the following journals: Journal of Developmental and Physical Disabilities, Journal of Intellectual Disability Research, Behavior Analysis in Practice, Education and Training in Autism and Developmental Disabilities, International Electronic Journal of Elementary Education, and Research in Developmental Disabilities. The four main criteria for inclusion in this literature review included: (a) single subject designs published between 2009 to 2019; (b) studies that included reinforcement-based practices to teach toilet training; (c) individuals diagnosed with ASD or other developmental disabilities; and (d) interventions intended to increase toileting acquisition.
For the purpose of this review, studies were excluded when punishment was part of the procedures (Sadler & Merkert, 1977; Smith, 1979), or when the participants did not have ASD or other developmental disabilities (Greer et al., 2016). Studies were excluded when they did not specifically target urination, or they only focused on bathroom-related behaviors such as drying hands, arranging shoes, covering buttocks, and tucking shirt (Ohtake & Takahashi, 2015). Many of the studies used strategies to increase both in-toilet voiding and toileting behaviors; these studies were included if they met the four main criteria stated above (e.g., Cocchiola et al., 2012; Drysdale et al., 2014; Frank et al., 2019; Lee et al., 2013; McLay et al., 2015).
Sample
Pooling the data from all studies reviewed, a total of 27 participants with Autism Spectrum Disorder or other developmental disabilities were included in these studies involving 24 boys and three girls. For those reporting, students had a mean age of 4.4 years (range 2.6 to 8.1). The median total number of subjects per study was three, ranging from one to five participants.
Research Design
All nine studies included in the review employed a single-subject research design. Three studies employed multiple baseline designs (Drysdale et al., 2014; Frank et al., 2019; Rinald & Mirenda, 2012), two studies used a non-concurrent multiple baseline design (Doan & Toussaint, 2016; McLay et al., 2015), and one study used a concurrent multiple baseline design (Cocchiola et al., 2012). Ardic and Cavkaytar (2014) implemented a multiple probe design, and in the final two studies, Kroeger and Sorensen (2010) used an ABA design while Lee et al. (2013) used a changing-criterion design.
Intervention Descriptions
Toilet Training and Video Modeling
Video modeling is an intervention that involves showing an individual the target behavior through the use of videos. The idea of video modeling is that the learner will eventually imitate the target behavior (McLay et al., 2015). According to Delano (2007), video modeling may take advantage of the child’s possible strengths in visual processing and his or her common interest in watching videos. These two advantages may increase the likelihood of the child’s ability to model behavior.
In 2007, Keen et al. examined the use of video-modeling for teaching toilet training. Using a commercially produced video, Keen et al. (2007) investigated the effectiveness of video modeling in teaching day-time urinary control to five children with autism. The results showed that video modeling in conjunction with operant conditioning may be more likely to increase toileting skills than when using operant conditioning alone for toilet training. However, the children did not achieve full toilet training. The study was not included in the review since it did not meet the criteria for inclusion based on the year of the study.
Following the research of Keen et al. (2007), Lee et al. (2013) utilized a similar approach using a toilet training video model. A changing-criterion design was employed to examine the effectiveness of video modeling using a customized video to toilet train a child with ASD. In addition, the intervention included toileting behaviors such as initiating use of the toilet, sitting on the toilet, pulling pants up and down, and flushing the toilet.
The participant in this study was a 4 year, 6 month old boy with ASD, and the intervention took place in his home. Pre-baseline data were utilized to identify an elimination schedule. While baseline data were collected, a toileting task analysis was introduced to the participant. Before the scheduled toileting times, the participant watched the video model. The child was then prompted to verbally request the toilet with the use of a picture card, and prompting was provided as needed to complete the steps in the task analysis.
The participant was provided with tangible reinforcers on completion of any of the six steps in the toileting task analysis. He was also provided with tangible reinforcers when mastery criteria were met for steps in the task analysis that were currently being targeted. The results of this study proved successful for teaching the toileting behaviors that could be seen in the video model (i.e. walking to the toilet, undressing, sitting on the toilet, redressing, and flushing). However, he did not master eliminating in the toilet which was the one step that was not actually shown in the video model.
As shown above, the previous research was inefficient at teaching in-toilet voiding, leading Drysdale et al. (2014) to attempt the use of an animated video model incorporating in-toilet voiding into the video model. Thus, the use of animation allowed for all steps in the toileting process to be depicted that would otherwise be considered inappropriate to record using a live model. This study examined the effectiveness of using a custom-made video model including animations to teach toileting skills. The participants in this study included two boys with ASD, a 4 year old and a 5 year old. A multiple baseline across behaviors design was employed with subjects seen in the participant’s home. Baseline consisted of identifying an elimination schedule for each participant and creating a toileting behaviors task analysis. The toileting behaviors included walking to the toilet, undressing, sitting on the toilet, in-toilet eliminations, redressing, and flushing the toilet.
During the intervention, the participants were shown the video model right before their scheduled elimination time. The video was incrementally introduced to the participants playing two steps at a time. Researchers employed the use of a chaining procedure allowing the participants to be prompted on the toileting behaviors that were not currently being targeted. Each instance of independently finishing a step in the task analysis independently was met with verbal praise. The results showed that both participants were successful in learning the behaviors involved in toileting as well as having actual in-toilet voiding. Although, it is not completely clear of the role that the use of animation played in the success of teaching all of the steps, including the actual in-toilet elimination, the use of animation in video modeling may be more suited to teaching more sensitive behaviors.
Finally, in the last study identified using video modeling for teaching toilet training, McLay et al. (2015) investigated the implementation of a video-modeling intervention package to toilet train two children with ASD. A non-concurrent multiple baseline design across participants was employed at both of the participant’s homes. The participants in this study included two non-verbal boys with ASD, ages: 7 years, and 8 years old. The procedures of the video modeling intervention package utilized animation to depict in-toilet voiding combined with prompting and reinforcement. A bathroom schedule and a toileting sequence task analysis was created for each participant. During the intervention, the video was played in segments for each step in the task analysis that the child was learning. Once the child met acquisition criteria of all steps, the full video was played before the child went to the bathroom. In conjunction with video modeling, prompting was implemented when necessary, and reinforcement was provided for following the steps in the toileting sequence and for in-toilet voiding. The results of this study indicated that video modeling, including animation, combined with prompting and reinforcement were effective in teaching in-toilet voiding, and toileting behaviors.
Toilet Training and Modified Intensive Toilet Training Method
As noted earlier, the RTT method, or the ITTM, was introduced by Azrin and Foxx in 1971 and included the use of punishment procedures. Additionally, it was often implemented in institutionalized or clinical settings. Over time, researchers began examining ways to modify the RTT method that removed the use of aversive consequences and focused on more positive procedures (Cicero & Pfadt, 2002). It is now referred to as the modified intensive toilet training method (MITTM).
Since the passage of the Individuals with Disabilities Education Act, 2004 (IDEA, U.S. Department of Education, 2004), schools have been charged with addressing student behaviors necessary for functioning in schools, such as toileting, and not just academic skills but are functional life skills. Although there is a vast amount of literature regarding toilet training, few studies deal directly with the issue of toilet training in school settings. In 2012, Cocchiola et al. developed a school-based toilet training program for preschoolers and demonstrated the effectiveness of interval toilet training for children with autism and developmental delays. The participants included five boys with ASD or other developmental delays between 3 and 5 years of age. A concurrent multiple baseline across participants design was implemented in the participant’s preschool classroom.
Baseline data were collected prior to the start of the intervention while the participants were still wearing diapers. At the start of the intervention, participant’s diapers were removed, and their fluid intake was increased. The participants were brought to the bathroom at 30-minute intervals to sit on the toilet until they voided or up to 3 minutes. Reinforcement was provided for in-toilet voids, while accidents were met with “You wet your pants. You need to change” and researchers would remain neutral while changing the participants and restarting their bathroom interval timer. The bathroom intervals were increased throughout the intervention for participants to learn to hold their bladder. The results of this research indicate that the toileting intervention was effective at increasing toileting behaviors within a school setting.
In 2014, Ardic and Cavkaytar, examined the implementation of the MITTM on teaching toileting skills to children with ASD. These procedures were different in that they did not include the three components of the original method. The modifications included a reduction in the duration of the procedures from eight hours to six hours, a device was not used to detect urination, and overcorrection was not used. A multiple probe design using probe sessions across subjects was implemented at the participant’s special education center. The participants included three males between 3 and 4 years of age.
The intervention consisted of increased fluid intake, dry checks, reinforcement for dry pants, or in-toilet voids. The students were given the instruction “go to the toilet.” The participants were brought to the toilet every 30 minutes, reinforcement was provided for every 10 minutes the participant had dry pants, if the participants were not dry during the dry check the researcher stated, “you are not dry,” removed any reinforcers, and changed the child with a neutral affect. Once the participant left the special education center for the day and went home, parents initiated one trip to the toilet with the participant after 1 hour and 50 minutes of being home with the intent to decrease in-home accidents. The results indicated that the MITTM was a successful method for teaching these children with ASD to in-toilet void and keep dry pants. Further, the elimination of the three components of the Azrin and Foxx (1971) study did not have a negative impact on the results of this study by Ardic and Cavkaytar (2014).
In 2019, Frank et al. extended on the previous research conducted by Cocchiola et al. (2012) in a naturalistic educational setting and followed the general protocol that was used in Cocchiola et al.’s study. This study examined the effects of a decision protocol to individualize toilet training interventions based on each participants’ needs. The participants in this study were three preschool boys with disabilities, all 4 years old. A delayed multiple baseline was implemented in the participant’s classroom. The decision protocol aimed to assist researchers and participant’s parents in selecting which intervention (interval toilet training (ITT) or RTT) would best suit their child throughout the intervention and adjust the intervention as needed. Parent support, classroom resources, and progress based on the decision protocol were all context variables that were considered in choosing the toileting intervention.Interval Toilet Training consisted of a participant sitting on the toilet every 30 minutes until a child had an in-toilet void, or 5 minutes had passed, while RTT consisted of the participant sitting on the toilet until an in-toilet void occurred in which the participant could earn time away from the toilet. The choice of intervention could be modified from ITT to RTT, or vice-versa if the researchers did not see skill acquisition on the target behavior. The results of the study indicated that the use of an individualized decision-protocol in-conjunction with either interval or rapid toilet training were effective at increasing in-toilet voids and decreasing accidents.
Parent-Implemented Toilet Training
Although some of the studies that have been examined do include parent involvement as part of the study (Ardic & Cavkaytar, 2014; Drysdale et al. 2014; Lee et al. 2013; McLay et al. 2015), three of the studies focused on parent training. Because of the difficulty children with ASD are frequently faced with when it comes to generalization of skill acquisition, Kroeger and Sorensen (2010) evaluated the effects of using a parent-delivered, intensive toilet training protocol in the child’s home. This intervention consisted of implementing a modified version of Arzin and Foxx’s (1971) RTT protocol. The participants in the study included two boys with ASD ages, 4 years, 11 months, and 6 years, 4 months.
Using an ABA design, the intervention was implemented by the parents in the participant’s home bathrooms. Parents were trained on the intensive toileting protocol before the start of the intervention without the use of punishment procedures, such as positive practice, environmental restitution or verbal reprimands. The participant’s fluid intake was increased prior to the start of the intervention. At the start of the intervention the participants were required to engage in scheduled sitting on the toilet with scheduled break times. Verbal and physical redirection (i.e., “We go pee-pee on the toilet.”) towards the toilet was used if the child began having an accident while on break. In the event of an in-toilet void, the child was provided with preferred tangible reinforcers and verbal praise. As participants began responding independently, they were then required to have scheduled sits in a chair. Instead of sitting on the toilet, they sat near the toilet. The sitting protocol was ceased when the participants met mastery criteria. Results indicated that a parent implemented toilet training protocol was effective in teaching and maintaining toilet training.
Following Kroeger and Sorensen’s (2010) research, Rinald and Mirenda (2012) examined the effectiveness of implementing a modified RTT workshop to parents of children with developmental disabilities including ASD. A multiple-baseline design across two participant groups was employed at the participant’s home. The participants included six children (three girls and three boys) who were between the ages of 3 and 5 years old, and one parent for each child. The intervention was split into three phases: baseline, a modified-RTT parent training workshop, and parent implementation of the modified-RTT procedures.
Parent training consisted of a four-hour program where parents were trained on the modified-RTT protocol which included training on scheduled toilet sittings, increased fluid intake, reinforcement for in-toilet voids, an accident protocol, and the procedure for scheduled chair sittings for toilet initiation, as described by Kroeger and Sorensen (2010). Throughout the parent-implemented intervention, the participants sat for timed scheduled sits on the toilet. If the participant independently voided in the toilet, the sit time was decreased, and the time off the toilet was increased. Parents were then taught to introduce scheduled chair sits, near the toilet, once the child had three-consecutive in-toilet voids. If the child had an out of toilet elimination, parents were instructed to bring the child quickly to the toilet to finish the elimination. If the elimination was finished inside the toilet, the child was praised and provided with reinforcement. If the elimination was not finished inside the toilet, parents changed the child and remained neutral. Parents were provided with the researchers contact information for answers to any additional questions during the course of the study. The results revealed that a parent-delivered toileting intervention was effective at increasing in-toilet urination. Additionally, a unique contribution of this study was the workshop on teaching parents to toilet train their children using role playing and video examples.
In the final study on parent training reviewed, Doan and Toussaint (2016) researched the effectiveness of the RTT program that was tailored to parental preference. Specifically, parents were given the option to exclude two common toilet training components (Azrin & Foxx, 1971), a urine alarm and positive practice. A non-concurrent multiple baseline across participants was employed across both the clinic setting and the participants homes setting. The participants were three boys with ASD between the ages of 2 and 5 years old.
The researchers collaborated with the participant’s parents to create individualized toileting interventions. All three of the participant’s parents chose not to use the urine alarm while all parents elected to use positive practice. However, one of the parents chose not to continue the use of positive practice after one implementation. The intervention consisted of increasing participant’s fluid intake, an elimination schedule, reinforcement for in-toilet eliminations, and communication training which consisted of prompting the child to request the bathroom. Positive practice was utilized if the participant had an accident. They were reminded “no wet pants” and brought to sit on the toilet. The results indicated that this intervention was effective at increasing self-initiations and decreasing out of toilet eliminations. Thus, developing an individualized intervention protocol that includes both practitioners and parents may increase the chance of a positive outcome for the child.
Discussion
Review of the literature indicates that overall results reveal that there are toilet training interventions that can increase in-toilet voiding for children with ASD and other developmental disabilities. Of the nine studies identified, eight of the interventions were effective at teaching in-toilet voiding, while the one study (Lee et al., 2013) that was ineffective for in-toilet voiding, was still effective at teaching toileting behaviors to children with ASD. All of the studies approached toilet training without the use of the punishment procedures utilized by Azrin and Foxx (1971), although Doan and Toussaint (2016) did use one of the punishment procedures, positive practice. Of the findings presented in this review, the research suggests that a modified version of Azrin and Foxx’s RTT that removes or reduces the punishment procedures to teach toileting behaviors, including in-toilet voiding, can be an effective alternative for children with ASD and other developmental disabilities.
Of the three studies that implemented video modeling as an intervention, Lee et al. (2013) created a custom-made video model which was implemented in combination with a toileting task analysis. Results showed that the intervention was ineffective at teaching in-toilet voiding, although it was effective at increasing the behaviors involved in toileting. Based on those findings, Drysdale et al. (2014) and McLay et al. (2015) expanded on the intervention by using an animated video model alongside a toileting task analysis. This proved to be effective at teaching in-toilet voiding and toileting behaviors. Further, the use of an animated video provided the privacy needed to teach sensitive behaviors such as toileting.
In addition to video-modeling toilet training procedures, three studies focused on MITTM in educational settings. Cocchiola et al. (2012) developed a school-based toilet training program for preschoolers with autism and developmental delays, while Ardic and Cavkaytar (2014) examined the implementation of the MITTM on teaching toileting skills to children with ASD in a special education center. They found the use of the MITTM to be an effective measure at teaching toileting skills. In the third study, Frank et al. (2019) extended on the previous research conducted by Cocchiola et al. (2012) and Azrin and Foxx (1971), in a naturalistic educational setting and found the use of a decision-protocol to be effective at increasing in-toilet voids and decreasing accidents.
The final three studies included in the review focused on parent-implemented toilet training interventions in the participant’s home. The studies reviewed included a parent-delivered, modified-RTT protocol (Kroeger & Sorensen, 2010) while Rinald and Mirenda (2012), following a four-hour modified RTT workshop to parents of children with ASD and other developmental disabilities, had the parents implement the toileting procedures. In the third study, Doan and Toussaint (2016) were effective at teaching toileting behavior using a RTT program that was tailored to parental preference. Although research is limited, it is encouraging to show that parents can potty train their children with ASD and other developmental disabilities at home using research-based protocols. Table 1 provides a synthesis of the studies.
Table 1
Increasing Independent Toileting in Children with ASD and other Developmental Disabilities
|
Citation |
Participants |
Design |
Intervention |
Results |
|
Ardic & Cavkaytar (2014) |
N= 3 Autism Ages= 3, 3, & 4 |
Multiple probe across subjects design |
Intensive Toilet Training |
Intervention was effective at increasing in-toilet voids |
|
Cocchiola, Martino, Dwyer, & Demezzo (2012) |
N = 5 Autism, & Developmental Disabilities Ages = 4, 4, & 6 |
Concurrent multiple baseline across participants |
Intensive Toilet Training in public school |
Intervention was effective at increasing toileting behaviors
|
|
Doan & Toussiant (2014)
|
N = 3 Autism Ages = 2, 4, & 5 |
Nonconcurrent multiple baseline design |
Parent-Oriented Rapid Toilet Training |
Intervention was effective at increasing in-toilet voids |
|
Drysdale, Lee, Anderson, & Moore (2014) |
N = 2 Autism Ages = 4 & 5 |
Multiple baseline across behaviors design |
Video Modeling
|
Intervention was effective at increasing in-toilet voiding |
|
Frank, Kim, & Fienup (2019) |
N = 3 Developmental Disabilities Ages = 4, 4, & 4 |
Delayed multiple baseline design |
Intensive Toilet Training Decision-Protocol
|
Intervention was effective at increasing in-toilet voids |
|
Kroeger & Sorensen (2010) |
N = 2 Autism Ages = 4 & 6 |
ABA across subjects design |
Parent-training model
|
Parent-delivered toilet training was an effective intervention |
|
Lee, Anderson, & Moore (2013) |
N = 1 Autism Age = 4 |
Changing criterion design
|
Video Modeling
|
Intervention was ineffective at teaching in-toilet voiding |
|
McLay, Carnett, Meer, & Lang (2015) |
N = 2 Autism Ages = 7 & 8 |
Non-concurrent multiple baseline across participants design |
Video Modeling |
Video-modeling intervention package was effective at teaching toileting skills |
|
Rinald & Mirenda (2012) |
N = 6 Autism Ages = 3, 3, 3, 3, 3, & 5 |
Multiple baseline across two participant groups design |
Parent-Implemented |
Modified RTT implemented by parents was effective at increasing in-toilet voids |
Limitations and Future Research
As with any review of research, there were limitations to be noted. With multiple interventions being studied it is hard to assess which would be the most effective for toilet training. Many of the interventions were very time consuming, and often required an entire bathroom to be available for the child which is not always feasible. Unfortunately, no matter which intervention is implemented, the process of teaching in-toilet voiding will always require multiple steps.
Only three studies were identified utilizing video modeling for toilet training between 2009 to 2019. Due to the limited research, the overall effectiveness of using video modeling for toilet training is still difficult to assess. Research has yet to be done using video-modeling independently as the only procedure in an intervention. Future research should attempt a video modeling intervention independently from chaining procedures. Further, research should focus on replicating and incorporating modified methods of video modeling to teach in-toilet voiding. Researchers should examine a cost-effective way to create and display a toileting video model. Due to privacy issues, the entire toileting routine cannot be displayed on a video model without the use of animation, fortunately Drysdale et al. (2014) and McLay et al. (2015) had success with this process.
Regarding the participants in this review, only three girls were included in the study conducted by Rinald and Mirenda, 2012. Although statistics show that boys are four times more likely to be diagnosed with autism than girls (Center for Disease Control, 2018), it is just as critical to include girls in evaluating the most effective methods of teaching toilet training. Further, these studies included preschool age children, but there are older children, teens and adults with ASD and/or developmental disabilities that are unable to toilet independently. There is a need for future research in this area as well.
Finally, each of these interventions are promising and has the potential to be a successful approach for children with ASD and other developmental disabilities. Thus, it is surprising that the research is limited in this area since toileting is a basic life skill that has to be taught to every child with or without disabilities. Replication of these studies is essential if our goal is to increase independence. Although this research may be time consuming, we need to consider whether the benefits outweigh the difficulties in conducting research in this area. The answer is “Yes, it does.”
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About the Authors
Vicky G. Spencer, Ph.D, BCBA-D, LBA, is a Professor in the Department of Psychology at Shenandoah University (SU) in Winchester, Virginia. She has over 25 years of experience as a university professor and researcher. Dr. Spencer’s areas of research include behavioral management strategies, cognitive learning strategies, and inclusive practices for all people.
Meghan Ello, M.S., BCBA, LBA, is a recent 2019 Master’s graduate in Applied Behavior Analysis at Shenandoah University in Winchester, Virginia. She is currently employed as a BCBA at Continuum Behavioral Health in Northern, Virginia. She is passionate about working with both children and adults, as well as their families, to help facilitate a meaningful change utilizing evidence-based ABA interventions.
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