Fact sheet: information on creating a behavior management program fora child with Autism, a common Autism Spectrum Disorder


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.


Click to shut this Autism personal story

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

Parents will usually understand that a child on the autism spectrum may have a few extra obstacles between him or her and dry pants.