Association for Behavior Analysis International

Toilet training is one area of applied behavior analysis that is practically manualized. Several studies have outlined an effective treatment package to improve toilet training for most subjects who participate (Azrin & Foxx, 1971; Foxx & Azrin, 1973; Greer et al., 2015; LeBlanc et al., 2015). The current symposium will present recent research in this area that focuses on 1) increasing the efficiency of toilet training and 2) improving the effectiveness of toilet training procedures. These studies will present modified toilet training programs, variations to individualized interventions, and methods for increasing both self-initiations to use the bathroom as well as continent bowel movements.

Behavior analysts who are providing services to individuals who are not fully toilet trained. Even if these clients are urine continent, they might still require bowel movement training and/or self-initiation training.

Independent toileting is an essential self-help skill for all children (Cicero & Pfadt, 2002). Typically developing children generally achieve continence by age 3 (Blum, Taubman, & Nemeth, 2003); however, over half of all caregivers of children with autism spectrum disorder (ASD) report difficulty in toilet training which causes the acquisition of toileting skills to be delayed or never mastered (Williams, Oliver, Allard, & Sears, 2003). For these individuals, incontinence can have a negative impact their personal hygiene, self-confidence, physical comfort, and social development (Cicero & Pfadt, 2002). Furthermore, incontinence can result in a restricted school placement, exclusion from extracurricular activities as well as hindering interactions with peers and increases burden of care. Numerous studies have evaluated variations on a study conducted by Azrin and Foxx (1971), which outlined an intensive behavioral treatment package for toilet training; yet, limited research exist on less intensive approaches. This study examines the outcomes of children who received toileting services through a consultative toileting program that primarily focuses on training the caregiver in how to implement toileting procedures. Additionally, the differences between children who were successful and those that were not were examined to determine if any pattern emerged.

Independent toileting skills provide multiple benefits (e.g., access to variety of settings and an increase in sanitation). Common procedures used to successfully train toileting skills include operant conditioning procedures with a positive practice component (LeBlanc, Carr, Bennett, & Detweiler, 2005). Given that positive practice is a form of punishment (Kroeger & Sorensen-Burnworth, 2009) and frequent exposures to punishment contingencies may increase the probability of evoking problem behaviors (Cicero & Pfadt, 2002; Post & Kirkpatrick, 2004), more research is needed to examine how punishment exposures within toilet training procedures can be reduced. The purposes of this study were to 1) replicate LeBlanc et al. (2005) for five children with autism, 2) evaluate the effects of schedule modifications designed to minimize the positive practice exposures during intensive toilet training for children who had accidents, and 3) after urine continence was achieved, evaluate generalization to bowel movements. The results of this study demonstrated that the toilet training procedures with schedule modifications were effective in training urinary and bowel movement continence across all children during intensive toilet training and follow-up. These results suggest that modifications to intensive toilet training procedures can be made to reduce the aversiveness of the procedure while still maintaining its effectiveness.