Association for Behavior Analysis International

The Association for Behavior Analysis International® (ABAI) is a nonprofit membership organization with the mission to contribute to the well-being of society by developing, enhancing, and supporting the growth and vitality of the science of behavior analysis through research, education, and practice.


46th Annual Convention; Online; 2020

Event Details

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Symposium #93
CE Offered: BACB
Advances in Efficiency and Effectiveness of Toilet Training Procedures
Saturday, May 23, 2020
3:00 PM–4:50 PM
Area: DDA/AUT; Domain: Applied Research
Chair: Sarah Slocum (Marcus Autism Center and Emory School of Medicine)
CE Instructor: Sarah Slocum, Ph.D.

Toilet training is one area of applied behavior analysis that is practically manualized. Several studies have outlined an effective treatment package to improve toilet training for most subjects who participate (Azrin & Foxx, 1971; Foxx & Azrin, 1973; Greer et al., 2015; LeBlanc et al., 2015). The current symposium will present recent research in this area that focuses on 1) increasing the efficiency of toilet training and 2) improving the effectiveness of toilet training procedures. These studies will present modified toilet training programs, variations to individualized interventions, and methods for increasing both self-initiations to use the bathroom as well as continent bowel movements.

Target Audience:

Behavior analysts who are providing services to individuals who are not fully toilet trained. Even if these clients are urine continent, they might still require bowel movement training and/or self-initiation training.


Consecutive Case Series Examining the Outcomes for Children With Autism Spectrum Disorder WhoReceived Services Through a Toileting Consultation Program

ELIZABETH BUCKLEY (Marcus Autism Center), Joanna Lomas Mevers (Marcus Autism Center), Colin S. Muething (Marcus Autism Center), Sarah Slocum (Marcus Autism Center and Emory School of Medicine)

Independent toileting is an essential self-help skill for all children (Cicero & Pfadt, 2002). Typically developing children generally achieve continence by age 3 (Blum, Taubman, & Nemeth, 2003); however, over half of all caregivers of children with autism spectrum disorder (ASD) report difficulty in toilet training which causes the acquisition of toileting skills to be delayed or never mastered (Williams, Oliver, Allard, & Sears, 2003). For these individuals, incontinence can have a negative impact their personal hygiene, self-confidence, physical comfort, and social development (Cicero & Pfadt, 2002). Furthermore, incontinence can result in a restricted school placement, exclusion from extracurricular activities as well as hindering interactions with peers and increases burden of care. Numerous studies have evaluated variations on a study conducted by Azrin and Foxx (1971), which outlined an intensive behavioral treatment package for toilet training; yet, limited research exist on less intensive approaches. This study examines the outcomes of children who received toileting services through a consultative toileting program that primarily focuses on training the caregiver in how to implement toileting procedures. Additionally, the differences between children who were successful and those that were not were examined to determine if any pattern emerged.


The Effects of Schedule Modifications on Toilet Training Children With Disabilities

NICOLE HOLLINS (Western Michigan University), Rebecca Kolb (University of Minnesota ), Stephanie M. Peterson (Western Michigan University)

Independent toileting skills provide multiple benefits (e.g., access to variety of settings and an increase in sanitation). Common procedures used to successfully train toileting skills include operant conditioning procedures with a positive practice component (LeBlanc, Carr, Bennett, & Detweiler, 2005). Given that positive practice is a form of punishment (Kroeger & Sorensen-Burnworth, 2009) and frequent exposures to punishment contingencies may increase the probability of evoking problem behaviors (Cicero & Pfadt, 2002; Post & Kirkpatrick, 2004), more research is needed to examine how punishment exposures within toilet training procedures can be reduced. The purposes of this study were to 1) replicate LeBlanc et al. (2005) for five children with autism, 2) evaluate the effects of schedule modifications designed to minimize the positive practice exposures during intensive toilet training for children who had accidents, and 3) after urine continence was achieved, evaluate generalization to bowel movements. The results of this study demonstrated that the toilet training procedures with schedule modifications were effective in training urinary and bowel movement continence across all children during intensive toilet training and follow-up. These results suggest that modifications to intensive toilet training procedures can be made to reduce the aversiveness of the procedure while still maintaining its effectiveness.

Evaluation of Mand Training Protocol and Abbreviated Toilet Training Procedure
ANSLEY CATHERINE HODGES (Nemours Children's Hospital), Hallie Marie Ertel (Florida Institute of Technology), Victoria Ryan (Florida Institute of Technology ), David A. Wilder (Florida Institute of Technology)
Abstract: Toilet training involves a time intensive multi-component treatment package. Research has demonstrated effective procedures to train individuals with and without intellectual disabilities to appropriately void (Azrin & Foxx, 1971; Foxx & Azrin, 1973; LeBlanc et al., 2015). More recent studies have evaluated the necessity of specific treatment components (Greer et al., 2015); however, to date, no study has evaluated a mand training protocol to teach individuals to appropriately mand to use the toilet. In the present study, we used a multiple baseline design across participants to evaluate the effects of a mand training protocol during an abbreviated procedure with six young children with and without intellectual disabilities. The results indicate that the procedure was effective in decreasing urinary incontinence and increase independent mands. Further, it took less time to implement than the procedure described in previous research. Results are discussed in terms of the utility and efficiency of the procedure for a variety of populations and settings.
An Evaluation of Bowel Movements, Problem Behavior, and Self-Initiations and Their Relationship to Urinary Continence
BRANDON C. PEREZ (University of Florida), Janelle Kirstie Bacotti (University of Florida), Kerri P. Peters (University of Florida), Timothy R. Vollmer (University of Florida)
Abstract: Much of the current research in applied behavior analysis on toilet training interventions for children with autism spectrum disorder (ASD) are replications and/or modifications of Azrin & Foxx (1971) or LeBlanc et al. (2005) procedures. These procedures differ from what is commonly used for typically developing children. For example, Greer et al. (2016) evaluated the effectiveness of three typical components presented within a toilet training package for typically developing children: a 30-min sit schedule, placing subjects in underwear, and differential reinforcement for remaining dry and eliminating in the toilet. Additionally, urinary continence is usually the dependent variable of interest in most toilet training interventions. In the currently study, we evaluated a less intensive treatment package (described by Greer et al.) on urinary continence in individuals with ASD. However, we also examined several secondary dependent variables (i.e., bowel movements, problem behavior, and self-initiations) to examine their relationship to the achievement of urinary continence.



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