TOILET TRAINING FOR STEVEN
Toilet
training for Steven Jones, currently aged 4.3, began at age
3. Before toilet training could begin, behavior issues such as noncompliance,
aggression, and tantrums were addressed. Once instructors had instructional
control, they met with Steven's parents to discuss the toilet training
program. With a new baby in the house, Steven's parents were anxious
to have him trained and out of diapers. Instructors explained that
toilet training took an extreme time commitment as well as diligence
on the part of the family.
The instructors explained that they would agree
to undertake toilet training Steven during their sessions if the
family would promise to carry through the program when the instructors
were not present. Steven's parents agreed and the instructors laid
out the plan. The plan included conditioning Steven's communication
skills so that he could request the bathroom spontaneously, teaching
him to tolerate being in the bathroom and sitting on the toilet
first clothed and unclothed, maintaining a toileting schedule and
data on each trip to the toilet as well as data on accidents, keeping
a log on bowel movements, and antecedent behaviors.
The first thing the instructors did was teach
Steven the words "toilet" and "bathroom". They
taught him to expressively and receptively identify both words using
a variety of mediums. Steven was taught in massed trials with tangible
rewards. Meaning that each item was repeatedly presented with a
stimulus, ex. With Steven seated in front of the instructor (knee
to knee), and the instructor holding up a picture, the instructor
said, "What is this?" Steven replied "bathroom"
correctly and was immediately rewarded with an edible and praise.
After Steven had learned the words "toilet"
and "bathroom", instructors taught Steven to tolerate
sitting in the bathroom. One of the traits of Steven???s autistic
disorder was extreme rigidity. He did not like the bathroom, except
for baths. Steven also was extremely averse to changing routines.
He associated the bathroom with baths and nothing more. To condition
Steven to tolerate sitting in the bathroom, instructors gave Steven
bits of his favorite candy and verbal praise for standing inside
the bathroom. They increased the time between rewards so that by
the end of week one, Steven was able to stand in the bathroom for
up to four minutes. By the end of week one, Steven's mother reported
that she had coaxed him to sit, fully clothed on the toilet. Instructors
helped shape the "sitting on the toilet" behavior by using
the same time interval/reward system to extend the ammount of time
he would sit, fully clothed on the toilet. Steven tolerated sitting
unclothed after learning to sit clothed with little problem.
By week two, instructors began encouraging Steven
to drink more fluids. They did this by feeding him small bits of
salty food (chips and pretzels) and continually offering preferred
fluids (Steven liked apple juice and water). This was done in order
to increase the opportunities for Steven to have successful voids
on the toilet. In other words, the more he drank, the more he would
have to "go". The more he would have to "go",
the more opportunities for success he had.
Instructors had asked parents to withhold Steven's
favorite treat, oreo cookies, when they began the training. Oreo
cookies were a very powerful incentive for Steven who loved them
and been very motivated by them in past learning situations. While
Steven was trained, he only received Oreos for successful voids
on the toilet, and not at any other time. This was done to increase
the value of the Oreos and give Steven more incentive to earn them.
Once Steven sat on the toilet unclothed and fluids
were being pushed, instructors implemented a toileting schedule.
The first week Steven was taken to the toilet every 15 minutes.
The routine occurred as follows: The timer went off, the instructor
physically prompted Steven to give them a picture of the toilet
and echoically prompted him to say, "I want toilet." Steven
was then guided to the bathroom, praised for dry pants if he was
dry, changed if wet, and sat on the toilet. If he voided, he was
immediately given an Oreo and allowed to return to the work area.
If he did not void, he sat for two minutes, then returned to work.
Once he had achieved two days of one or fewer accidents, the 15
minute intervals was increased to 25 minute intervals. Once he was
able to remain dry on that schedule (it took two more weeks), the
schedule was relaxed to 35 and then 45 minute intervals. Steven
remained dry on this schedule for two more weeks and when instructors
attempted to eliminate the schedule and teach spontaneity, Steven
had a setback. He began wetting himself. This was treated with over
correction for accidents: When Steven had an accident, he had to
change all his clothes and clean his chair or the area where he
was when he had the accident. These activities were aversive to
Steven and served as further incentive to void in the toilet. At
this time, it was decided that Oreos were not motivating enough
to teach spontaneity. After performing a reinforcement assessment,
Steven's reward for voiding in the toilet was changed to five minutes
of watching a preferred video. Both the over correction and extremely
motivating reward allowed for achievement of the goal of Steven
initiating use of the toilet independently.
Once bladder training was successful, bowel training
began. During bladder training, Steven's family kept a log of times
when Steven moved his bowels. They found that the times Steven generally
moved his bowels was between 4 and 6pm daily. They also isolated
certain antecedent behaviors to this activity. Before Steven "went",
he usually hid in a corner, crouched down and got a far away look
in his eyes.
To train Steven to move his bowels on the toilet,
instructors had to wean Steven off going in his diaper - which was
very familiar and comfortable for Steven. They did this by working
and playing with Steven in the bathroom during target times (4-6pm).
During initial phases, Steven wore a diaper. When he displayed antecedent
behaviors, they had him sit on the toilet, with his diaper on (the
diaper was removed for urine voids), and rewarded him for voiding
in his diaper while sitting on the toilet. They then cut increasingly
bigger holes in his diaper over the next few weeks, so that eventually,
he was having bowel movements on the toilet, with only the waist
of the diaper around his waist. They then were able to completely
eliminate the diaper.
After 12 total weeks of toilet training, Steven
was able to independently request to use the toilet for both bladder
and bowel use, with accidents occurring only in isolated incedents.
See these fact sheets as well: Introduction
to toilet training and Toilet
training styles.
Click here for the full range of Asperger's and autism fact sheets and personal stories at www.autism-help.org
Reproduced with permission of Tom McIntyre from his site at www.BehaviorAdvisor.com
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