Page 1 Toilet Training Presented by: Brittain Coleman, MA, BCBA Tracy Palm, MS, BCBA

Page 2 Method #1 Habit training is a type of toilet training in which the goal is to develop toileting behavior through repeatedly doing a behavior in the same way over and over.

Page 3 Who is Habit Training appropriate for? No awareness of need to urinate/defecate Person is over 5 years of age & other training techniques have been unsuccessful Individual is cognitively functioning age 3 or lower No awareness or change in behavior when diaper or clothes are wet

Page 4 Starting a Habit Training Program Know your childs current bladder & bowel schedule. Keep your child on a regular diet, including drink consumption, and exercise throughout. Pick times that are 5-15 minutes before your child typically goes. Develop visual aids to show each step, this can be very useful if you have a visual learner. Find a timer that will be used for Habit Training only.

Page 5 Habit Training Cont. Tell the individual that when the timer goes off that he/she is going to take a potty break. Set the timer for the predetermined time. When the timer goes off then tell the child, its potty break time. Prompt the individual as need to go through the steps of toileting. You can use other ABA procedures to teach the steps of toileting, such as behavior shaping, chaining, differential reinforcement, etc.

Page 6 Habit Training Cont. The individual does not have to sit for a long period of time. Start out with just having the individual sit for a few seconds. As the person becomes more compliant and independent with the tasks of toileting then you can extend the time that the individual is required to sit. After the individual has completed the toileting tasks then reinforce the behavior.

Page 7 What to do if the individual has limited or poor awareness… Applying physical pressure on the lower abdomen over the bladder in order to allow complete emptying of the bladder. –Consult for doctor, PT or OT Trouble with beginning urination? Try turning on the faucet or pouring lukewarm water over a boys penis Relax- Some people need to be distracted in order to relax enough to go. Use toys, books, running water, etc.

Page 8 Teaching Bowel Movements This usually follows bladder control. Is there something reinforcing the behavior of going in the diaper or in another location? Use pictures that clearly show what the child is to do and expect.

Page 9 Does it work? This was a 3 yr old, child with ASD. He was vocal. He was unable to tell when he went.

Page 10 References Ando, H. (1977). Training Autistic Children to Urinate in the Toilet Through Operant Conditioning Techniques. Journal of Autism and Childhood Schizophrenia, 7, Fouse, B., & Wheeler, M. (1997). A Treasure Chest of Behavioral Strategies for Individuals with Autism. Arlington, TX: Future Horizons, Inc. Wheeler, M. (2007). Toilet Training for Individuals with Autism or other Developmental Issues. Arlington, TX: Future Horizons, Inc.

Page 11 Questions? Contact Information: Tracy Palm, MS, BCBA Founder/Executive Director Transformations Autism Treatment Center (901) office

Page 12 All to often it seems as if toilet training is not addressed until later in childhood and sometimes not until teenage or even adult years SO I wanted to face this issue head on… Common Trends

Page 13 Method #2: Direct Contingency Toilet Training Based on the method created by Foxx and Azrin, 1971, 1973 Method replicated multiple occasions with the same general results

Page 14 Direct Contingency Training Direct Contingency Training is comprised of several different components: Intensive schedules for: Time on potty Time off potty Fluid intake Programmed Consequences for: Successful Urinations Self-Initiations Positive Practice for accidents Communication Training

Page 15 Intensive Schedules Hour:Sit on Potty How much time between sits Drink Schedule 15 min sit5 min offevery 5 minutes 24 min sit10 min offevery 10 minutes 33 min sit15 min offevery 15 minutes 42 min sit25 min offevery 30 minutes 51 min sit35 min offevery 30 minutes 61 min sit45 min offevery 30 minutes 71 min sit60 min offevery 30 minutes 81 min sit1.5 hours offevery 30 minutes 9 1 min sit 2 hours offevery 30 minutes 10 1 min sit 2.5 hours offevery 30 minutes 11 1 min sit 3 hours offevery 30 minutes 12 1 min sit 4 hours offevery 30 minutes

Page 16 Programmed Consequences Frequent mini preference assessments are conducted A few of the more highly preferred reinforcers are used only for toilet training Delivery of reinforcers are contingent upon the following two behaviors: Successful Urinations Self-Initiations

Page 17 Positive Practice Positive Practice for accidents Tell the client No wet pants in a firm voice in the spot where the client had an accident. Take the client to the potty and have the client sit on the potty for 30 seconds. While the client is on the potty provide little to no attention. After the 30 seconds on the potty return to the location where the client had the accident and repeat steps 1 & 2 five times unless during one of the times on the potty the client has a successful urination. IF THE CLIENT HAS A SUCCESS: praise the client, sing songs, and deliver a reinforcer. Positive practice discontinues until the next accident.

Page 18 Participants 6 participants All under 3 years old 5 boys, 1 girl 2 completely non-verbal 4 with limited language skills

Page 19 Results 4 of the clients are now considered potty trained by our standards 2 of the clients discontinued potty training for the following reasons: 1 of the clients temporarily discontinued all services due to illness The other client discontinued potty training as per the parents requests because of personal reasons HOWEVER, the data for the two clients who discontinued potty training was consistent with the 4 other clients who were successful

Page 20 Results: Client # 1

Page 21 Results: Client # 2

Page 22 Results: Client # 2 cont

Page 23 Results: Client # 3

Page 24 Results: Client # 3 cont

Page 25 References Azrin, N. H., & Foxx, R. M. (1971). A rapid method of toilet training the institutionalized retarded. Journal of Applied Behavior Analysis, 4, 89–99. LeBlanc, L. A., Carr, J. E., Crossett, S. E., Bennett, C. M., & Detweiler, D. D. (2005). Intensive outpatient behavioral treatment of primary urinary incontinence of children with autism. Focus on Autism and Other Developmental Disabilities, 20, 98–105.