An extension of commonly used toilet‐training procedures to children with autism spectrum disorder

Abstract

The current study evaluated a toilet-training treatment package described by Greer et al. (2016) with children diagnosed with autism spectrum disorder (ASD). Most of the current research on toilet-training interventions for children with ASD are replications and modifications of Azrin and Foxx (1971) or (more recently) LeBlanc et al. (2005). However, these procedures are composed of components that are not included in studies with typically developing (TD) children. For example, Greer et al. evaluated the effectiveness of three typical components within a toilettraining package, mostly with TD participants: a 30-min sit schedule, placing participants in underwear, and differential reinforcement. The primary purpose of the current study was to replicate and extend the treatment package described by Greer et al. to children with ASD. A secondary purpose was to evaluate modifications necessary for individualized toilet training when the commonly used components were ineffective. The results of Greer et al. were replicated for 11 participants with ASD in the current study, suggesting that intensive toileting interventions (e.g., interventions requiring overcorrection, reprimands, and dense sit schedules) may only be necessary for a subset of individuals with ASD.

Classroom Based Intensive Toilet Training for Children with Autism Spectrum Disorder

“…This is relevant considering the requirement of behavior analysts and classroom teachers to avoid punitive measures if possible (Behavior Analysis Certification Board 2014;Council for Exceptional Children 2015). This study extended the findings of previous research by incorporating strategies to teach self-initiation (Cocchiola et al 2012;Kroeger and Sorensen-Burnworth 2009) and exposure to underwear prior to intensive interventions (Greer et al 2016;Perez et al 2020).…”

“…In a component analysis, Perez et al (2020) found that ITT packages may not be necessary for some students with ASD. Additionally, Greer et al (2016) found wearing underwear to be the most important component for toilet training packages for young children and for some, this component alone was sufficient in improving continent voids with young children.…”

Evaluating bowel movements, self‐initiations, and problem behavior with the emergence of urinary continence

“…However, some comprehensive toilet training studies do not mention BMs (e.g., Cocchiola et al, 2012;LeBlanc et al, 2005). Those that have mentioned BMs have specified that the same contingencies that were in place for urinations remained in effect for BMs (e.g., Greer et al, 2016;Kroeger & Sorensen, 2010;Perez et al, 2020;Rinald & Mirenda, 2012). For example, in Greer et al (2016) and Perez et al (2020) appropriate BMs resulted in praise and access to preferred items, whereas BM accidents resulted in minimal attention and participants' clothing being changed.…”

“…Some toilet training studies have reported the occurrence of BMs across phases of the intervention (Perez al., 2020;Rinald & Mirenda, 2012) or included a follow-up survey with questions about BM continence (Lomas Mevers et al, 2018). However, with only these relatively coarse measures, it remains unclear how the likelihood of appropriate BMs might be affected by improvements in urinary continence.…”

“…However, with only these relatively coarse measures, it remains unclear how the likelihood of appropriate BMs might be affected by improvements in urinary continence. Perez et al (2020) reported changes in appropriate BMs across phases of the toileting intervention (see Table 3 from Perez et al, 2020). These data were variable and indicated that some individuals had improvements in appropriate BMs, while others had no effect or seemed to have a decrease in appropriate BMs.…”