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Article - The Adventure of Toilet Training by Alexis Eggenberger, MSSA, LISW-S, BCBA

Tuesday, April 19, 2016 5:43 PM | Renee Canfield (Administrator)

Close your eyes, clear your mind, and concentrate on this phrase:

Toilet training.

 

What are the words and images that come to mind? For some parents, toilet training was easy. For others, not so much. Potty training can be very difficult for some children and many parents become easily overwhelmed and frustrated.

 

As a behavior analyst, I’ve treated many children with potty training challenges.  Although it seems bizarre, toilet training is one of my favorite focuses in behavior therapy. I absolutely love toilet training because the outcome is simple: either you do it appropriately (eliminate on the toilet) or you don’t (have an accident).  Of course, there are many curves and obstacles that might occur during the toilet training road trip, but the end goal is the same for everyone – independent toileting. I’ve had the pleasure of training children from the age of 3 to the late age of 19, and it’s an amazing feeling to have parents say, “I never thought he could do this” at the end of therapy.

 

So, if you’re on the journey of toilet training and you’ve hit a few road closures or if you haven’t yet mapped out your voyage, hop in and buckle up!

 

The average child is ready to begin toilet training around 18-30 months of age. University of Michigan states that by 3 years old, 98% of children are toilet trained during the day. (Nighttime training is a completely different story and could have a blog dedicated entirely to it. For the purpose of this blog, we will focus on day training only.)

 

How do you know when your child is ready to begin training? Typically, when kiddos are ready to begin the process, they show an interest in the potty, can stay dry in their diaper for at least 1 hour at a time, have some form of communication skills, have predictable bowel movements, and demonstrate some form of physical signs during elimination (squatting, running away, and glazed-over eyes).  Please keep in mind, though, not all children will demonstrate these readiness skills. Children with autism and Down syndrome, for example, may not demonstrate the readiness skills similar to their peers. This does not mean you should wait until they are “ready”. For some children, they will never demonstrate these signs, and you’ll be waiting forever. The first toilet training case I ever had was a 19 year old with autism. The caregivers continued waiting until he was ready to train, but he never seemed to be. Overnight, it seemed, he turned 19.

 

Toilet training can be a lengthy process, as you may know. Some children may achieve this skill immediately, and others might take several months. When starting a toilet training plan, I always recommend that families are able to commit to at least 3 months without major changes. If a new baby is coming, a change of homes is anticipated, or a big vacation is planned, wait until after these events have occurred.

 

Once you’re ready to start, you’ll want to first take data on your child’s current toileting behaviors. Do this BEFORE you remove the diapers/pull-ups. In order to do this, simply record whether he is wet or dry every half hour. This will give you a rough idea as to his typical toileting pattern. Most people show a pattern in their toileting behaviors, and this can help when scheduling toilet sits in the future. Once you’ve taken data for 3-10 days, you’re ready to begin.

 

Materials Needed:

·         Underwear (lots of it!)

·         Extra clothing

·         A small insert for the toilet seat (if your child is smaller)

·         A footstool to allow for a 90 degree angle at the knees when sitting

·         Preferred beverages (not including milk)

·         Preferred toys that can be used during toilet sits (books, iPad, etc.)

·         Strong reinforcers (small favorite toys, snacks, or other tangible items that are not available during any other part of the day. This is very important – if the items are available freely throughout the day, the child has no incentive to participate in the process.)

·         Schedule of toilet sits. Once you’ve taken data on your child’s typical toileting times, you can use this information to predict when she might eliminate. I typically start toilet sits every 30-60 minutes, with longer periods of time after successes.

 

Procedure:

1.       About 15-20 minutes prior to the scheduled sit time, provide your child with about 6-8 ounces of a preferred beverage. This will increase the likelihood that your child will need to eliminate.

2.      At the scheduled toilet time, communicate to your child that it’s time to use the bathroom. ***For children who are highly resistant to even entering the bathroom, you’ll need to start with a pairing procedure first. Essentially, you’ll want to engage your child in fun activities that occur just outside or around the bathroom, while gradually moving yourself into the bathroom. During this time, no directives are given regarding toileting. You’re simply making the bathroom a fun place to be!

3.      When you enter the bathroom, prompt your child to pull his pants down and sit on the toilet. It’s often helpful if your child is wearing sweat pants or other easily-removable pants during the initial training sessions. Depending on your child’s developmental level, you can provide physical assistance during this step if needed.

4.      While sitting on the toilet (and making sure knees are at a 90 degree angle with the stepstool), provide your child with books, iPad, or other small objects. Tell your child to “go potty”.

5.      If he successfully eliminates, say “Great job going potty!” and provide him with a small treat (favorite toy, snack, or other item). While the germophobe in me hates this, it’s very important that the reinforcer is given to your child immediately after he eliminates and is still sitting on the toilet. This will help him understand that eliminating on the toilet is the appropriate response. For example, if Johnny urinates on the toilet, say “Great job going potty!” and give him a Skittle immediately.

6.      If he does not successfully eliminate, say nothing and prompt him to pull up his pants.

7.      Whether your child eliminated or not, it’s always a good idea to practice hand washing!

8.     When accidents occur (they will!), change your child quietly, without making eye contact or saying anything. If able to do so, prompt your child to assist in the clean-up (wiping self, throwing away diaper).

9.      After several days of success, begin to fade the reinforcers (Example: provide one Skittle after two eliminations, then one Skittle after three eliminations, and so on). You’ll want to make sure you’re not fading too quickly or the skill will not be maintained.

10.  During the entire process, make sure to take data! Identifying times of accidents, times of successes, and other issues will help you to adapt your sitting times and procedure. This will create an individualized experience for your child, which is more likely to be successful.

 

And that’s it! Easy, right? Of course not. Remember, toilet training is a journey. It’s playing the game of Candy Land and constantly being sent back to Mr. Mint, Grandma Nutt, and Lord Licorice. Some players are lucky – they pick color cards each time (sometimes doubles!) and never have to move backward. Others aren’t so lucky and experience the two-steps-forward, one-step-back (or one-step-forward, two-steps-back) game of potty training.

 

At the end of the day, remember to keep pushing on! While there may be setbacks, independent toileting is a goal for all of us. Support one another and consult a professional when needed. We are always here to help!  

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