Most parents agree that one of the most essential skills for all children to learn is independent toileting. In a blog on her website Mary Lynch Barbera, BCBA & author of the “Verbal Behavior Approach”, states that it is one of the top three goals for any child or adult with autism in order to access the community. But the whole experience can seem overwhelming, with many parents wondering where to start. In this series of blogs about toilet training, I will discuss some of the pre-requisite skills that need to be in place ready to start toilet training with your child. Then, when these are established, the follow up posts will talk through the different strategies that can be used, breaking the skill down into manageable steps.
We have been successful in targeting toilet training with clients from 3 years old to 18. We have found that there are two main “routes” to go down when working on toileting; one adapted from Foxx and Azrin’s “Toilet Training in Less Than a Day” (1973) and the other a slower paced “habit training” from “Toilet Training Procedures For Individuals With Developmental Disabilities” by Diana Browning Wright(1998). We would choose which route and programme to use depending on the child and their family. Bladder training is usually established before bowel, and daytime toileting is established before night-time toileting is targeted. We usually go straight to teaching a child to urinate on the toilet, using a smaller seat that can be placed on the toilet for younger children, rather than using a potty and then having to transfer the skill over to a toilet. We teach girls and boys to urinate while sitting initially – “target” practise with boys is a whole other programme!
Before starting toilet training, there are some pre-requisite skills that need to be in place. Toileting isn’t usually the 1sttarget that we would work on as a child needs a good level of co-operation and an understanding of the contingency between doing something and then getting a reward, or reinforcement.
If a child is unhappy even sitting on the toilet, you may also need to pair the bathroom and toilet with reinforcement. This could be especially important if there have been unsuccessful attempts to toilet train in the past. This could mean initially that the child sits on the toilet fully clothed for a set period of timeto watch a favourite DVD or play with a favourite toy, then in their nappy and then without.
Taking a drink when asked to do so is another pre-requisite skill, as an increase in fluids is sometimes needed when toilet training.
It is also recommended to take some data on when your child typically drinks and then urinates. This can be done by conducting checks throughout the day. This will give a better idea of how often your child does urinate and if there’s a time of day that it is most likely to happen, which would be especially useful if using the habit training model.
When you are ready to start toilet training, make sure there are no upcoming events that may disrupt the process – such as a family holiday, the birth of a sibling or house move. Ensure that everyone around the child, such as school staff, know the toileting plan so that there is consistency for your child.
Choose a highly preferred item that can be delivered to the child after they have successfully urinated on the toilet, such as access to the iPad or a favourite edible. This should be something that the child only gains access to after going to the toilet in order to build a strong contingency.
Now you should have many of the tools in place to start toilet training. I will next describe the “habit training” programme and then the more intensive toileting programme.
By Rhian Thorne, BCABA