Tuesday, May 22, 2012

“Let’s Go Potty!” A Three-Phase Teaching Procedure for the Initial Stages of Toilet Training

“Let’s Go Potty!”
A Three-Phase Teaching Procedure for the Initial Stages of Toilet Training
Jennifer Rodecki, M.Ed.
Deb Leach, Ed.D., BCBA

Caregivers and teachers of children with ASD and other disabilities are always looking for helpful hints on toilet training. Truthfully, there are multiple skills that must be taught to fully toilet train a child. This reading will provide a description of how to introduce a child to the beginning steps of toilet training.

Phase 1:  When first beginning toilet training, you will simply be working on getting the child comfortable with sitting on the toilet several times throughout the day.  During this phase of the training, the child will continue to wear diapers or pull-ups.  It is important to do your best to avoid making the toilet training aversive for the child.  Do not force the child to sit for a certain length of time during Phase 1. You should provide large amounts of positive reinforcement while the child is in the bathroom, on the toilet, and after the child sits on the toilet during this initial phase.  This can be through the use of social reinforcement, activity reinforcement, or tangible reinforcement. The purpose of providing positive reinforcement is to pair toilet training with things the child finds enjoyable to increase the child’s willingness to participate in toilet training.  When telling the child it is time to use the bathroom, use a consistent phrase each time, such as “Let’s go potty.” Take the child into the bathroom. If the child will not sit on the toilet, start by giving the child the reinforcer while he or she is standing in the bathroom. After 2 – 3 times of receiving the reinforcer while standing in the bathroom, withhold the reinforcement until the child sits on the toilet. While the main goal during Phase 1 is not to get the child to actually eliminate while sitting, if the child happens to do so, be sure to provide meaningful positive reinforcement.

Phase 2:  Once the child is sitting on the toilet for seconds at a time, you should begin increasing the length of time you expect the child to sit on the toilet before providing the reinforcer. You should start with thirty seconds of sitting before getting the reinforcement. After the child is able to sit for thirty seconds for 2 – 3 times, increase the time requirement to one minute.  Once the child has sat on the toilet for one minute, give the reinforcer. Continue this for 2 – 3 successful trials and then increase the time requirement to two minutes. Continue this procedure until you reach five minutes. Some children may not be able to sit for five consecutive minutes. In this case, 2-3 minutes should be their time limit. If the child eliminates in the toilet give verbal praise and a highly preferred reinforcer.

Phase 3:  Once the child is comfortable with sitting on the toilet a few times each day, it is time to begin potty training without diapers.  Bring the child to the potty on a fixed schedule.  The fixed schedule can be every 20 minutes, 30 minutes, 40 minutes, etc.  It depends on your child’s frequency of elimination.  During this phase, be sure to record the times that the child is having accidents. This recording should last 3-5 days. While recording accidents, it is also important to note when the child has had any food or drink. It is likely that you will notice a correlation between the child’s consumption of food and drinks and the accidents. After 3-5 days, you should start to notice a pattern developing of when your child is having accidents.  Once you notice a pattern, begin taking the child into the bathroom about 5-10 minutes before you are expecting the accident.  Do not provide any negative consequences if/when your child has an accident.  Accidents are part of the learning process.  React unemotionally, bring the child to the bathroom, say something such as, “You pee on the potty,” and clean up the mess without making an issue out of it.  During this phase, give verbal praise and a highly preferred reinforcer when the child eliminates in the toilet.  The reinforcers can be gradually faded out once using the toilet becomes more of a regular pattern for the child.

These steps provide the child with an introduction to toilet training.  Keep in mind that these procedures should be implemented consistently, and that it may take a couple of weeks to several months for accidents to cease depending on the child.  It’s important to continue with the steps outlined even when accidents are occurring.  These procedures are not only designed for young children.  Jennifer (first author) used these procedures with middle school students with moderate-severe autism who were not potty trained.  She was able to get all students potty trained at school within several months.  While there are additional procedures for getting to the point where the child is completely independent with using the toilet, being able to use the toilet on a schedule without accidents is the first step to independently using the bathroom.   

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