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Independent toileting is generally considered a core adaptive skill and one which individuals with ASD may find a challenge to master. The inability to independently toilet oneself is associated with a number of negative consequences including the potential for reduced participation in community resources. While other effective methods of toilet training appear in the literature (e.g., Azrin and Foxx, 1971), the researchers sought to document the efficacy of the current intervention as one that may be more acceptable to administrators, teachers, and other direct care workers.

Study participants included three young (ages 4-6 years) learners with a previously established autism diagnosis. At the time of the study, all three were untrained, wore diapers, and had urination accidents on a daily basis. All training took place in the bathroom of the individual’s school. At the start of the intervention a timer was set for 30-minute intervals. At the end of each interval, the student was prompted to request “bathroom.” The student was prompted to sit on the toilet for approximately 1 to 3 minutes with appropriate urination reinforced with behavior-specific praise and tangible positive reinforcement. If he/she did not urinate, he/she was prompted to stand, re-dress, and was told, “Ok, you don’t have to pee.” No verbal praise or tangible reinforcement was delivered. If the initiation of a urine accident was noted, the teacher would deliver a statement meant to startle the student and interrupt the flow of urine while prompting the student to the toilet. If appropriate urination then occurred, reinforcement was delivered and if not, the student was changed out of his/her wet clothes without any further consequence.

The results indicated that for all three students the self-initiation of requests for the bathroom in the absence of toileting accidents was achieved in seven to 11 days and gains were maintained over 6-month and 12-month follow ups.

References

Cicero, F.R., & Pfadt, A., (2002). Investigation of a reinforcement-based toilet training procedure for children with autism. Research in Developmental Disabilities, 23, 319-331.