Toilet Training Made Semi-Easy

(Note: Kent Moreno is a Behavior Analyst and father of a child with Down syndrome. He is employed by the West Virginia Austism Training Center at Marshall University as an education specialist. He can be reached at  knm@access.mountain.net.)

The process of teaching a child to use the toilet can be a frustrating one. This is especially true if the child has a developmental disability. The protocol listed below has been used successfully, with individuals with developmental disabilities of all ages.

In addition to the protocol listed below, It can be helpful if a child is able to observe others using the toilet. This may be something which a family is not comfortable with or is not appropriate in certain settings. That's fine.

A major factor in the success of this program is based on the development of an effective toileting schedule. To determine the right schedule for the child, data needs to be taken for at least 2-3 days on how often the child goes to the bathroom. To do this, dry pants checks should be done every 20 - 30 min (20 minutes is preferable). If your lucky, you can find diapers which have a strip which changes color when the child voids otherwise, it will be necessary to feel for moisture. Take special care to write down the times of the day that the child defecates as most people defecate at approximately the same time each day. This procedure is called baseline data. Once 2-3 days of data has been gathered, it will be necessary figure out approximately how often the child goes to the bathroom. To do this, divide the number of waking minutes by the number of times the child went to the bathroom.

The toileting schedule can now be set up. As a rule of thumb, the child should be taken to the bathroom, twice as often as the child's average for urinating and defecating. So, for example, if the child goes to the bathroom an average of once an hour, the child would be taken to the bathroom every 1/2 hour. When setting up the toileting schedule, keep in mind the times of the day that the child is most likely to defecate and try to have the toileting schedule occur close to these times.

Prior to taking the child to the bathroom, give the child a cue that it is time to go to the bathroom. I recommend helping the child to make the sign for toilet until they can make it independently. Using the sign for toilet will not stop those children who are verbal from saying "toilet" and will give the child a way of communicating when they have to go to the bathroom once they have mastered the toileting procedure thus making a toileting schedule unnecessary.

It is important that the bathroom be a very fun place. Reserve a couple of the child's favorite toys or books which they can only have access to while they are seated on the toilet. Also, music can be very helpful. Mozart and Rockabilly seem to work well.

When having the child sit on the toilet, don't force it. The experience needs to be a positive one. If the child doesn't want to sit on the toilet, leave the bathroom and try again at the next scheduled time. Also, don't have the child sit on the toilet for more than 5-7 minutes. If the child is going to void in the toilet, they will usually do it within that time frame. If the child voids in the toilet, make a big deal out of it, praise the child verbally and tactilely (hugs, pats on the back...) and give them access to a small very preferred edible reinforcer (not always necessary). While it will be important to reduce the use of the edible reinforcers as quickly as possible but, in the early stages of acquiring toileting skills, it will be more important to make voiding in the toilet an extremely momentous and positive experience for the child.

One modification which can be made to the protocol which many times will increase the child's rate of success at voiding in the toilet is to give them something to drink 15-20 min prior to the scheduled toileting time.