Association for Behavior Analysis International

Azrin and Fox (1971), LeBlanc et al. (2005), and Lomas Mevers et al. (2018) empirically evaluated procedures for toilet training individuals with disabilities. More recently, Greer et al. (2016) demonstrated a treatment package for toilet training typically developing individuals. The current symposium will include four presentations on replications, component analyses, and extensions of common toilet training practices.

This presentation is for any behavior analysts who might be toilet training clients.

To date, most of the research on autism spectrum disorder (ASD) has focused on males; therefore, little is known if there are differences in the manifestation of ASD between males and females. One example involves daytime enuresis, a behavioral issue commonly observed in children with ASD (Von Gontard, Pirrung, Niemczyk, & Equit, 2015). Intervention for daytime enuresis typically involves systematic fluid loading to increase opportunities for voiding, a progressive sit schedule with positive reinforcement for successful voids, and return to sitting upon episodes of incontinence (Lomas Mevers, Muething, Call, Scheithauer, & Hewett, 2018). The goal of this study was to conduct a consecutive case series analysis of outcomes of an intensive toileting program for treatment of daytime enuresis in children with ASD. We examined treatment outcome data from 2014 until 2018 and compared outcomes between males and females. Results demonstrated low significance between outcomes of males and females in terms of procedure modifications and final criteria met, and high significance in terms of performance during 6-month follow-up with males significantly more likely to have positive, long-term success. Results will be discussed in terms of the physiological and behavioral aspects that might affect females performance during intervention for day time enuresis.

LeBlanc et al. (2005) described an effective, intensive outpatient procedure to decrease urinary incontinence among children with autism. This procedure included programmed consequences for appropriate urination and self-initiation, the provision of increased fluids, the use of a urine sensor to detect accidents, training a mand for elimination, and overcorrection contingent upon inappropriate urination. In the present study, we replicated and abbreviated LeBlanc et al.’s procedure by omitting the use of a urine sensor and overcorrection contingent upon accidents. We used a multiple baseline design across participants to evaluate the effects of the abbreviated procedure with three young children who were nonresponsive to non-intensive toilet training procedures. The results suggest that the procedure was effective to decrease urinary incontinence among all three children. Further, it took less time to implement than the procedure described by LeBlanc et al. Results are discussed in terms of the utility and efficiency of the procedure for a variety of populations and settings.

Young children between the ages of 13-30 months begin to have the skills necessary to begin the process of toilet training. However, delayed toilet training of typically developing children has become a trend (Simon & Thompson, 2006). Delayed training can have negative health, financial, and social implications. To date, we have systematically replicated the intensive toilet training procedure described by LeBlanc et. al (2005) with seven children (ages 22-58 mo) with and without intellectual and developmental disabilities for whom the treatment package described by Greer et al. (2016) was not immediately effective. A nonconcurrent multiple baseline was used to evaluate the training procedure, which consisted of a graduated sit schedule, reinforcement of successful urinations and self-initiations, increased fluids, communication training, a urine sensor and alarm, and positive practice for accidents. Results showed that the LeBlanc training procedure was effective for rapid performance acquisition that generalized and maintained in the preschool classroom for 5 of 7 subjects. Results are discussed in terms of treatment efficacy and efficiency, generality of procedures across populations (children with and without IDD), and social validity of treatment procedures in early childhood education and intervention environments.

Behavior Analysts working with children with autism spectrum disorder (ASD) and other intellectual and developmental disabilities, especially in early intervention type settings, are commonly asked for assistance in toilet training. Most of the current research in applied behavior analysis on toilet training interventions for children with ASD are replications and/or modifications of Azrin & Foxx (1971) or LeBlanc et al. (2005) procedures. These procedures differ from what is commonly used for typically developing children. For example, Greer et al. (2016) evaluated the effectiveness of three typical components presented within a toilet training package for typically developing children: a 30-min sit schedule, placing subjects in underwear, and differential reinforcement for remaining dry and eliminating in the toilet. These components were evaluated both in isolation and together in a treatment package with 19 typically developing and 1 child diagnosed with ASD. The primary purpose of the current study is to evaluate the effectiveness of the three aforementioned components, that are typically used in toilet training procedures for children, but in this case for children with ASD. If these procedures were ineffective, a secondary purpose was to evaluate elimination patterns to allow researchers to identify modifications necessary for individualized toilet training.