Categories: ASD and DD, Child-focused
Toilet training any child can be a challenging task, but toilet training children with developmental disabilities can be particularly daunting for caregivers. Often, these children respond best to intensive toilet training programs based on the principles of behavior analysis.
In their book, Toilet Training in Less than a Day, Nathan Azrin and Richard Foxx describe toilet training procedures based on the principles of behavior analysis. These procedures work well with typically developing children and may be helpful to parents of children with autism spectrum disorder (ASD) and other developmental disabilities.
Before parents start toilet training, they should find strong rewards to entice and encourage their child. Depending on the child’s preferences, edible items or access to new or favorite toys may provide effective reinforcement.
Sometimes, children may have already developed challenging behaviors in the bathroom and may be unwilling to sit on the toilet. In these cases, parents might start by rewarding the child for simply entering the bathroom, then for approaching the toilet, and eventually for sitting on the toilet for progressively longer periods.
Often, children with developmental disabilities may not have a way to communicate their need to use the toilet. Teaching the child to use sign language to request the toilet or give the parent a picture of the toilet or a small dollhouse-size toilet may enable him or her to communicate the need to use the bathroom. Using the chosen communication method throughout training will allow the child to have the practice s/he needs to continue to use the skill in many different settings after training is complete.
If parents choose to use an intensive toilet training approach, they can begin by having their child sit on the toilet until s/he urinates. Children with developmental disabilities need to practice new skills frequently, so giving the child plenty of tasty beverages to increase the number of learning opportunities should be helpful. Sometimes, drinking can be encouraged by giving the child salty snacks. When the child is successful, parents should celebrate and present him or her with the reward.
After the child has experienced some success, s/he can wear underwear and sit next to the toilet. If the child shows signs of needing to use the toilet, the parent can use very mild prompts to encourage the child to go to the toilet. Parents should be careful not to offer prompts too often or too strongly so the child does not become dependent on the prompts. The child should stay in the bathroom next to the toilet until s/he can get up and approach the toilet independently when s/he needs to use it. After the child experiences more success, the chair can very gradually be moved away from the toilet.
During toilet training, children learn that keeping their pants clean and dry is desirable. Parents can set a timer and reward their child every few minutes for keeping dry, clean pants. They can prompt their child to feel their underwear each time they are checked. The time between checks can be gradually lengthened as s/he successfully uses the toilet.
What about toileting accidents? For some children, earning rewards and enjoying the feeling of clean, dry pants is effective, but other children benefit from correction procedures. Often these procedures include both practice and restitution components. For example, the child may be required to practice going from the site of the accident to the toilet several times. The child might also help clean up the site of the accident and change their clothing.
Toilet training children with developmental disabilities may be very taxing; but helping them learn this very important skill will build their independence and contribute to their continued success at home, in school environments, and out in the community.
By Shannon Kay, Ph.D., BCBA-D