The Autism Society Event and Education Recordings Archive

            Toilet training among children with disabilities has changed drastically in the past 35 years. To begin, four decades ago, Azrin and Foxx (1971) pioneered a behavioral approach in the use of Rapid Toilet Training (RTT) to toilet train adults with cognitive disabilities. The researchers reported a dramatic improvement in independent toileting among the participants involved due to the use of positive reinforcement as well as positive punishment (Azrin & Foxx, 1971). Since that ground breaking research, there have been numerous variations of RTT applied among individuals with disabilities (Carr, Crossett, Bennett, & Detweiler, 2005; Chung, 2007; Kroeger, & Sorensen, 2010; Post & Kirkpatrick, 2004; Sikkema, Bosman, Duker, & Curfs, 2001). All of the studies incorporated positive reinforcement when toilet training, an important ethical consideration and best practice when working among children with special needs.

            Recently, researchers have created several variations to positive reinforcement-based interventions that appear to be promising when toilet training children with autism. For example, Keen, Brannigan and Cuskelly (2007) focused on using video modeling along with operant conditioning techniques to aide individuals with autism in toilet training. The study evaluated video modeling paired with operant conditioning techniques in comparison to use of operant conditioning techniques alone and a control group with no intervention at all. The results indicated that when video modeling was used in conjunction with operant conditioning, participants achieved the most success for urination in the toilet (Keen et. al., 2007).

            Many professionals have opinions about toilet training to also include advice that can be helpful to parents. Boutot (2009) suggested that the first step is looking for signs that a child is ready to toilet train. For example, the child should be able to somewhat control their bowels and urinary tract muscles which can be indicated by the child remaining dry for a period of one to two hours.  . In addition, children should be about two and half years old when beginning the process (Boutot, 2009).

            When programming for toilet training, three steps can make the process easier for everyone involved. To begin, baseline data should be collected to indicate the times of day the child typically wets and/or soils their diaper next, start by taking the child to the toilet during times of the day when they typically wet/soil themselves. One practical suggestion is to make all diaper changes in the bathroom, so the child can associate that room with the toileting function. Children should not be punished for unsuccessful toileting; rather, children should be praised for successful approximations (Boutot & Tincani, 2009).  Reinforcement-based practices such as sticker charts (i.e., token economies) and dense praise should be integrated into the process to promote mastery with independent toileting.    

            Once a child gains consistency using the toilet, generalization is imperative so that the child understands how to access and use the toilet across a variety of settings (e.g., at grandma’s house, in the community, and with a variety of different types of toilets).  Kroeger and Sorensen (2010) used planned generalization to implement this aspect of toilet training.  The child was first trained on one toilet located in the home, and once the child showed reliable continence in the one bathroom setting, the child was then introduced to and required to use a different toilet in the home. After this generalization occurred, the child was then required to use other facilities such as school, library, and the grandparent’s house.

            In summary, this poster will describe evidence-based practices to promote a systematic toilet training approach for children with autism. The presentation will put forward a summary of research that has previously been conducted and found to be successful for individuals with disabilities.  In addition, participants will gain knowledge of positive reinforcement practices for use during toilet training. Visual supports and token economies will also be integrated into the poster in effort to provide user friendly, quick tips that promote efficient mastery of toileting for children with autism. The practical suggestions are intended to support functionality for individuals in effort to increase life-long independence and self-efficacy.