Abstract
“A rapid method of toilet training- The institutionalized retarded” is a research journal of incontinent male patients-Azrin & Fox Article Summary. The research was set for institutionalized patients for toilet training with each patient allocated four days. The participants ranged from 20 years to 62years of age, and it is recorded that they often urinated and soiled themselves. In the process of the implementation of reinforcements and training, little progress was recorded. Urine apparatus and potty training were used as reinforcements to establish behavioral change.
The hospital’s staff played a significant role in maintaining consistency in the implementation of the reinforcers (Azrin, & Foxx, 1971). Initial studies showed no positive results. When a psychological model of toilet training was applied, tremendous progress was recoded. Thus, their mechanism for utilizing the behavioral and social approach was to manipulate the environmental factors to attain social reinforcement. This process would eradicate the shame and guilt of defecating on one’s clothes. Also, it would support the independent use of the toilet.
Problem
The problem in this study was dealing with incontinence in adult patients. This behavior was consistent among institutionalized adults. The patients were recorded to have an intelligence quotient (IQ) of 30 or less than that. Some had mental disorders that either affected their sight or their speech. Therefore, these health limitations affected their ability to comprehend more complex instructions. Also, it contributed to the difficulty in understanding how to control bowels and bladder movements.
Additionally, social interaction was nonexistent in this institution, and this reduced the chances of imitating desired behavior or adapting to a particular daily routine (Azrin, & Foxx, 1971). This factor limited the toilet training previously undertaken by the institution’s practitioners, for the patients. They had remained non-adaptive to being toileted after every meal. Furthermore, the isolation brought loneliness, which is a hindrance to new adaptation. The mentioned issues affected toilet training despite regular toilet routines.
Procedure-Azrin & Fox Article Summary
The first step in the procedure was the selection process. Patients were selected randomly for a specific treatment category or control group. Each patient was assigned depending on the number of accidents each selected. The treatment group was tested, followed by the control group. Residents were placed in post-training maintenance. The concept of toilet training was established and taught as a learning process (Azrin, & Foxx, 1971). Mistakes were allowed during the first attempts of toileting.
A generalized procedure was established by the use of positive reinforcers to eliminate the previous toileting training. A three days baseline was created for the keen observation of each resident. They were observed consistently for 8 hours and would be frequently checked if they had wet/soiled their clothes.-Azrin & Fox article summary
The training procedure involved the administration of fluids to the patients after every thirty minutes to facilitate urination. Detected changes and responses were continuously recorded for 12 days for each resident. The patients with reinforcers were checked after every 5minutes to determine if they had not wet or soiled their clothes. If any accidents occurred for patients with pant alarms, then the trainer would disconnect the device. They would be taken to the laundry area to clean up themselves.
Also, they would clean the laundry area in case of any water spillage because they hand washed the dirty clothes (Azrin, & Foxx, 1971). They would be deprived of extra food or drinks and a chair. However, Residents who relieved themselves in the toilet would be provided with immediate reinforcement. This positive reinforcement would be rewarded through edible or social interactions.
Results-Azrin & Fox article summary
Initial efforts by the staff members bore no fruits. They became pessimistic of the probability of change because of the fails they faced in every attempt. However, once they started incorporating scientific training methods provided by the trainers, there was a massive transformation. Before the trainers intervened, each resident would soil their clothes at least twice in every 24hours.
After toileting training, the accidents reduced dramatically, and by the fifth month of re-examining, the accidents vanished almost entirely (Azrin & Foxx, 1971), except for a few who reported soiling or wetting their clothes once a day. The journal records that by the end of the research, the accidents had reduced by 80%. To maintain the improvement margin, the trainers had to teach the staff how to implement these reinforces in their absence.
The institution’s staff were trained on the basics of toilet training and what reinforcers to use to maintain the desired behavior. They were tested for comprehensibility, through a question and answer formula. In addition, they were taught the applications of change techniques under the supervision of the trainers (Azrin, & Foxx, 1971).
On the third day, the trainers took a seat back to monitor how the staff implemented their guidelines, and they were proven to have understood everything. After five months, trainers returned to assess the effectiveness of maintenance, and the institution reported that no accidents had been reported for one month.
Discussion
The trainer’s interventions worked magically to eradicate bowel and bladder incontinence. Through their aid, residents were able to adapt to normalcy despite their medical limitations. All the devices used, including the pants alarms, were effective and affordable. The sound they emitted when they got in contact with moisture was neither destructive nor annoying to the whole entity.
Therefore, they could be used effectively (Azrin & Foxx, 1971). Based on the findings, incontinence was contributed majorly through initial training. The training limited the patients from voluntarily taking action. The training was practical because of the incorporation of social, psychological, and physical stimuli, which attracted positive change.
Article Summary
Reference
Azrin, N. H., & Foxx, R. M. (1971). A Rapid Method of Toilet Training the Institutionalized Retarded1. Journal of applied behavior analysis, 4(2), 89-99.