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Telehealth is rapidly expanding; however, few studies have investigated hybrid models that include synchronous and asynchronous components. While research recognizes the importance of tailoring interventions to meet individual child needs, we have yet to understand how to tailor interventions to parent characteristics. This study examined how baseline parent characteristics (n = 25) were related to asynchronous material usage in a hybrid coaching via telehealth intervention for potty training in children with autism. Results suggested that parents with lower baseline competence used the asynchronous materials more frequently than parents with higher baseline competence and were more likely to make greater gains in parent competence between pre- and post-intervention. There were no differences between groups on the acceptability of the intervention. Future research should examine multiple baseline parent characteristics in a larger sample to better understand how to tailor interventions to meet both parent and child needs.

Extended diaper wearing may limit access to inclusive opportunities including general education settings, summer camps, community-based programming, and job opportunities. Toilet training may be delayed due to more pressing concerns, such as challenging behavior. Individualized education plans should include toilet training children with intellectual and developmental disabilities (IDD) experiencing urinary accidents due to the consistency and availability of resources associated with school settings. Researchers have demonstrated that toilet training in the school setting can lead to continence for children with IDD with minimal long-term disruptions to the school day. The purpose of this study was to evaluate the effects of changing the garment type prior to implementing a classroom-based toilet training package for preschool-aged children with IDD. Researchers evaluated the effects of the garment type and toilet training package on on-toilet voids and initiated voids with a concurrent multiple probe across participants research design. All three participants reached continence and two participants began initiating trips to the restroom.

Toileting skills are a milestone typically achieved by the age of four. For many caregivers, particularly those who have children diagnosed with autism spectrum disorder or other developmental disabilities, teaching toileting is a challenge resulting in delayed implementation. Delaying toileting increases the risk of challenges to acquiring this skill. Caregivers are fundamental and research shows that their involvement supports the maintenance and sustainability of this skill. Four caregivers were taught a 24-step toilet training program to teach toileting. Behaviors measured included urination success, urine accident frequency, and child requests for the bathroom. All caregivers learned the 24-step procedure and the toilet training package was effective in teaching three of the four children daytime urine continence.

Undertaking infant-toddler practicum during initial teacher education is critical to ensuring preservice teachers (PSTs) are well prepared for their future role as early childhood teachers. PSTs, however, can face challenges in infant-toddler practicum given the demands of this unique teaching and learning context. A knowledgeable, experienced educator as a guide is key to supporting PSTs' learning during placement. This paper illuminates the practices of an infant-toddler educator who supported an international PST's learning during her first nappy change on an infant-toddler practicum in an early childhood service in Australia. The paper addresses the scarce literature on PSTs' experiences in infant-toddler settings, which can guide their relationships with colleagues. Drawing on the theory of practice architectures, we analyse a video vignette of the PST and educator during a nappy changing practice. We highlight the practices of both the educator and PST which helped the PST learn by being 'stirred in' to this common but unfamiliar practice for her and many other PSTs who may never have held a baby before. Implications call for cooperative and experienced educators who can support PSTs with pedagogical and practical elements of the practicum.

The purpose of this article is to provide early childhood teachers with an approach to classroom-based toilet training for urination when less intensive toilet training methods are unsuccessful. The focus of this article is on urination, but improvements in on-toilet urination may be correlated with an increase in on-toilet defecation (Perez et al., 2021). However, in some cases defecation may require more intensive procedures for continence (Mevers et al., 2020). This article emphasizes the importance of collaboration with caregivers, planning for generalization and maintenance, and data collection. The toilet training protocol described includes (a) progressive sitting schedules, (b) diaper removal, (c) fluid intake, (d) initiation training, (e) and teacher responses to off and on-toilet voids.

The current study describes the use of a procedure called the "potty party", an all-day toilet training method using basic learning principles of "errorless" discrimination with 3 children with incontinence diagnosed with autism. At the start of treatment days, each participant was greeted and prompted to request the bathroom. After the child requested the bathroom, they were taken to the restroom, pants and underpants were removed, the child was seated on the toilet. While on-seat, participants were given liquids, less-preferred reinforcers and engaged in typical daily activities such as discrete trial training. When the child voided in the toilet, specific verbal praise and highly preferred edible reinforcers were delivered. The child was also given time off the toilet with their most preferred toys or items/activities. Time off-toilet subsequently increased with each in-toilet urination until the participants were spending the same amount of time off-toilet, out-of-bathroom, and in the classroom as their peers. Results for all three participants using 3 non-concurrent A-B phase designs indicated that the potty party procedure was effective in decreasing accidents to zero levels for all three participants and increased in-toilet urination for two. Future directions for research in toileting are discussed.

Early studies evaluating the relative preference for leisure compared with edible items suggested that, for most participants (>80%), edible items are more preferred than leisure items. Recent studies suggest more variability in the percentage of participants with this preference. The rationale for this variability could be sampling, setting, availability of items outside of the study, or the items included. As a systematic replication, we conducted preference assessments of leisure, edible, and leisure/edible items combined of 13 children with developmental disabilities. As an inclusion criterion, all participants had an electronic item as the top-preferred leisure item. An edible item ranked first in the combined assessment for 46.2% of participants. This replicates recent findings while accounting for access to edibles outside of the study. These outcomes are important to guide use of preference assessments across reinforcer classes in clinical and school settings.

Past studies in autism have shown that individuals with Autism Spectrum Disorder (ASD) exhibit impairments in their toileting skills due to their cognitive skills. Hence, a 10-month intervention programme was developed to help ASD children aged 3 to 5 years old to master toileting skills. This multiple baseline design study sets out to examine the effectiveness of a parental intervention. Moreover, a visual prompt approach was used in the intervention and it helps to enhance the child's processing ability. Quantitative data collection (frequency recording forms) were used to record the number of occurrences on the targeted behaviours on their toileting skills which then converted to percentage correct to find out the mastery criterion level of the children. The findings showed that five children with ASD had successfully satisfied (80% above) most of the performance criteria on the toileting skills that had been taught to them by their parents. In contrast, the whole performance criteria on the toileting skills were only mastered well by one of the subjects. This finding has proven that early intervention on toileting skills based on parents and learning tools (busy bags) may help motivate learning among children with ASD.

This study's purpose was to elucidate the experiences of educators raising and responding to child-related concerns within Early Childhood Education and Care settings. Parent satisfaction with interactions, educators' ratings of how well interactions went, and educator confidence related to raising or responding to concerns, were examined. Participants were 302 parents and 118 educators from 19 long day care and/or kindergarten services in Victoria, Australia. Results revealed child behaviour, toilet training and social development concerns were most often discussed, and most parents felt satisfied with interactions they had with their child's educator about those concerns. Overall, educators reported favourably about their own interactions. Some negative experiences reported by parents, and educators' comments about successful components of raising and responding to concerns, provide key insights into effective communication and relationship-building strategies. This study addresses the importance of active skills-based training for early childhood educators in communicating effectively with parents.

The purpose of this study was to investigate the effects of an intensive toilet training program on continence and self-initiation for elementary children with autism spectrum disorder (ASD). Researchers used a non-concurrent multiple baseline design (Watson and Workman in J Behav Ther Exp Psychiatry 12:257-259, 1981, https://doi.org/10.1016/0005-7916(81)90055-0) with regulated randomization (Koehler and Levin in Psychol Methods 3(2):206, 1998, https://doi.org/10.1037/1082-989X.3.2.206) to evaluate the effects of the intensive protocol with four students with ASD in the classroom where they received special education services. The protocol included increased access to fluids, contingent time intervals for sit schedules, programmed reinforcement, and dry checks. All four participants met mastery criteria and maintained independent toileting after the study's completion. Three participants began self-initiating to use the restroom. The implications and recommendations for future research are discussed.

Approximately 50 years of research on rapid toilet training (RTT) first used by Azrin and Foxx (1971) indicates RTT is effective for teaching individuals with intellectual and developmental disabilities (IDD) independent toileting routines. Professionals focused on toilet training may be familiar with RTT procedures but be less informed about the frequency and duration of RTT application. We systematically reviewed the intervention research focused on rapid toileting training to better understand the intensity of RTT in the intervention research literature. Results indicated intensity varied considerably by study but suggest RTT will require approximately 30-min inter-sit intervals for six days per week, for a total of 373 hours to produce the effect. Implications for research and practice are discussed.

The current evaluation assessed the effectiveness of a rapid toilet training procedure for three young males with autism. The evaluation extended the research on rapid toilet training procedures by assessing parents' preference to include two common toilet training components, a urine alarm and positive practice. In addition, we assessed child challenging behaviors during intervention. All parent participants' elected not to use the urine alarm, and one parent elected to discontinue the implementation of positive practice techniques. All child participants engaged in challenging behavior with the initiation of toilet training. The toileting intervention was successful as all three participants increased successful self-initiations for the toilet and decreased accidents across home and clinic settings. All parents provided favorable social validity ratings of the treatment. Findings suggest that clinicians should partner with parents to develop individualized toileting interventions that are appropriate and effective.

Being able to independently and correctly complete a toileting routine is an important developmental milestone for all children, but for children with Autism Spectrum Disorder (ASD), it may be an extremely difficult skill to acquire (Keen et al., 2007). The focus of this review was to examine the effectiveness of the current research on three common interventions including video modeling, the modified intensive toilet training method (MITTM), and parent-delivered toilet training for increasing in-toilet voiding in children with ASD. Nine single-subject design studies were identified from 2009 to 2019. The overall results of the toilet training intervention studies have shown the procedures reviewed to be effective in increasing in-toilet voiding. Future research should focus on replicating and expanding these interventions, but also combining these interventions to see if the effects would produce more positive results for children with ASD and toileting issues.

Learning toileting routines often occurs later for students with autism spectrum disorder (ASD). Many factors affect the delay that a family may experience in trying to toilet train a child with ASD, so having teamwork between home and school is vital for success at mastering the routines associated with independent toileting. Consistency, communication, and routine are the hallmarks of success. There must also be some consideration for the unique sexual, emotional, and sensory needs of a child with autism who is trying to learn any new task.

We describe a decision protocol for choosing among potentially efficacious toilet training interventions and tested its effects with 3 preschool participants with disabilities. We utilized a decision protocol (Keohane and Greer 2005) to determine whether to initially implement interval or rapid training interventions as well as to determine whether adequate progress was being made with a particular toilet training intervention. We utilized the decision protocol to individualize toilet training procedure and evaluated its effects in a delayed multiple baseline design. Results indicated that the toileting skills of all participants improved with increased numbers of target voids on the toilet and decreased numbers of accidents as a result of individualized training procedures.

Children with autism spectrum disorder (ASD) are often delayed in achieving bowel continence, resulting in negative outcomes. In this pilot trial, 20 children with ASD and encopresis were randomly assigned to multidisciplinary intervention for encopresis (MIE; n = 10) or a waitlist control group (n = 10). The MIE group was treated for constipation and received a 10-day behavioral intervention that utilized suppositories to produce predictable bowel movements that were reinforced. Caregivers were trained to implement the intervention. Results support the feasibility of clinical trials of MIE, with high enrolment, competition, attendance, and caregiver acceptability. Preliminary outcomes were positive, with six of 10 in the MIE group achieving continence by the end of treatment compared to 0 in the control group (p = 0.005).

Teaching toilet training skills to children with autism spectrum disorder (ASD) can be challenging. Many techniques use Azrin and Foxx's Rapid Toilet Training method (RTT). However, some children with ASD find the first RTT step of entering the bathroom or restroom to be challenging due to the relatively loud sound of the toilet flushing. Although more schools and public settings are utilizing the automatic flush toilets, effective strategies for overcoming the fear of the sound is limited to non-existent. The current study utilizes shaping to assist a preschool student with ASD overcome her fear of entering a restroom.

The current study evaluated a toilet-training treatment package described by Greer et al. (2016) with children diagnosed with autism spectrum disorder (ASD). Most of the current research on toilet-training interventions for children with ASD are replications and modifications of Azrin and Foxx (1971) or (more recently) LeBlanc et al. (2005). However, these procedures are composed of components that are not included in studies with typically developing (TD) children. For example, Greer et al. evaluated the effectiveness of three typical components within a toilet-training package, mostly with TD participants: a 30-min sit schedule, placing participants in underwear, and differential reinforcement. The primary purpose of the current study was to replicate and extend the treatment package described by Greer et al. to children with ASD. A secondary purpose was to evaluate modifications necessary for individualized toilet training when the commonly used components were ineffective. The results of Greer et al. were replicated for 11 participants with ASD in the current study, suggesting that intensive toileting interventions (e.g., interventions requiring overcorrection, reprimands, and dense sit schedules) may only be necessary for a subset of individuals with ASD.

Functional independence in toilet training involves muscle control, the awareness and desire to stay dry, and the child's ability to dress themselves. This is a natural and gradual process beginning at home, and Sarah Moudry gives clear and encouraging ideas for supporting this process at school once the child is walking. [This talk was presented at the NAMTA conference titled "Montessori from Birth to Six: In Search of Community Values," (Minneapolis, MN, Nov 7-10, 2013).]

Incontinence, psychological symptoms, parental stress and psychopathology were examined in 51 children (43 boys, mean age = 9.7 years) presented in an outpatient clinic for autism spectrum disorders (ASD) and in 53 matched controls (43 boys, mean age = 10.2 years). All children were clinically assessed for ASD, incontinence and psychopathology according to current guidelines. ASD was confirmed in 37 children and excluded in 14. Enuresis (16.2%) and daytime urinary incontinence (16.2%), but not fecal incontinence (8.2%) were more common in ASD than in controls. Children with ASD showed significantly more comorbid psychiatric disorders. Parents of children with ASD experience more stress. Parental stress was predicted by parental psychopathology, role restriction and group (patient/control), but not by incontinence.

We developed an iOS-based app with a transmitter/disposable sensor and corresponding manualized intervention for children with autism spectrum disorder. The app signaled the onset of urination, time-stamped accidents for analysis, reminded parents to reinforce intervals of continence, provided a visual outlet for parents to communicate reinforcement, and afforded opportunity for timely feedback from clinicians. We compared this intervention with an intervention that uses standard behavioral treatment in a pilot randomized controlled trial of 33 children with autism spectrum disorder aged 3-6 years with urinary incontinence. Parents in both groups received initial training and four booster consultations over 3 months. Results support the feasibility of parent-mediated toilet training studies (e.g., 84% retention rate, 92% fidelity of parent-implemented intervention). Parents used the app and related technology with few difficulties or malfunctions. There were no statistically significant group differences for rate of urine accidents, toilet usage, or satisfaction at close of intervention or 3-month follow-up; however, the alarm group trended toward greater rate of skill acquisition with significantly less day-to-day intervention. Further development of alarm and related technology and future comparative studies with a greater number of participants are warranted.

This paper interrogates how school toilets and 'school readiness' are used to assess children against developmental milestones. Such developmental norms both inform school toilet design and practice, and perpetuate normative discourses of childhood as middle-class, white, 'able', heteronormative, cissexist and inferior to adulthood. Critical psychology and critical disability studies frame our analysis of conversations from online practitioner forums. We show that school toilets and the norms and ideals of 'toilet training' act as one device for Othering those who do not fit into normative Western discourses of 'childhood'. Furthermore, these idealised discourses of 'childhood' reify classed, racialised, gendered and dis/ablist binaries of good/bad parenting. We conclude by suggesting new methodological approaches to school toilet research which resist perpetuating developmental assumptions and prescriptions. In doing this, the paper is the first to explicitly bring school toilet research into the realms of critical psychology and critical disability studies.

Sensory over-reactivity may be related to atypical defecation habits in children with constipation. The Toileting Habit Profile Questionnaire-Revised (THPQ-R) is designed to identify defecation-related sensory issues. This study examined the discriminative and concurrent validity of the THPQ-R. Differentiating between children with and without constipation was used to establish discriminative validity. The relationship between scores on the THPQ-R and on the defecation scale of the Virginia Encopresis-Constipation Apperception Test (VECAT-S) was examined to establish concurrent validity. The difference in THPQ-R scores was statistically significant. There was a strong positive correlation between the over-reactivity section of the THPQ-R and VECAT-S scores. Results support using the THPQ-R to identify atypical defecation behaviors.

This research develops a context-sensitive understanding of infant toilet training that takes account of a diversity of influences on the phenomenon. Data are drawn from a qualitative study of everyday life in families with young children. Parents in 54 families living in Norway were interviewed about the everyday life of the family during their child's first year of life, and two follow-up interviews were conducted with 15 families in subsequent years. A contrastive-comparative approach to the analyses takes account of the social actions, related to toilet training, in another cultural context in order to better grasp the taken-for-granted assumptions about toilet training evident in one's own culture. The analyses identify the significance of cleanliness-related regimes in toilet training. The cleanliness regimes were adjusted for parents' everyday life considerations, which involved parental wishes to relate to the child as an individual subject; take the child out in public spaces; share care between parents; and involve other persons in the child's care. A developmental perspective on parental practices and everyday life considerations provides a broadened understanding about later toilet training in Western contexts.

In this paper we argue that school toilets function as one civilising site [Elias, 1978. "The Civilising Process". Oxford: Blackwell] in which children learn that disabled and queer bodies are out of place. This paper is the first to offer queer and crip perspectives on school toilets. The small body of existing school toilet literature generally works from a normative position which implicitly perpetuates dominant and oppressive ideals. We draw on data from Around the Toilet, a collaborative research project with queer, trans and disabled people (aroundthetoilet.wordpress.com) to critically interrogate this work. In doing this we consider 'toilet training' as a form of 'civilisation', that teaches lessons around identity, embodiment and ab/normal ways of being in the world. Furthermore, we show that 'toilet training' continues into adulthood, albeit in ways that are less easily identifiable than in the early years. We therefore call for a more critical, inclusive, and transformative approach to school toilet research.

The study investigated whether age at attainment of 20 developmental milestones within the areas of language, walking, eating, dressing, social interaction, and toilet training was associated with adult intelligence. Mothers of 821 children of the Copenhagen Perinatal Cohort recorded 20 developmental milestones at a 3-year examination, and all children were administered the Wechsler Adult Intelligence Scale when they were 20-34 years old. Later attainment of a number of milestones was associated with lower adult IQ with the strongest associations found for those related to language and social interaction. The adjusted full-scale IQ means were 107.0, 101.8, and 100.6 for being able to form a sentence at less than 24 months, at 24 months, and later than 24 months.

There is a growing trend toward later toilet training of typically developing children. This trend is a problem for caregivers and professionals who work with young children, because it is associated with a number of costs and health risks in child-care settings. Results of a recent study (Tarbox, Williams, & Friman, 2004) suggest that wearing underwear may facilitate the development of toileting skills. Based on these findings, we examined the effects of wearing disposable diapers, disposable pull-on training pants, and underwear on urinary continence of 5 typically developing toddlers in a child-care setting. Underwear decreased incontinence and increased continent urinations for 2 of the 5 participants, produced no improvement in 2 participants, and when combined with increased fluid intake and longer sitting periods, produced some favorable trends for the 5th participant. (Contains 1 figure.)

In 2009, Kroeger and Sorensen-Burnworth published a comprehensive review of the literature on toilet training individuals with autism spectrum disorder and other developmental disabilities. Their review highlighted that the majority of toilet training programs were modelled after Azrin and Foxx's Rapid Toilet Training (RTT) method. The current study will review toilet training programs for the developmental disability population since 2009. Behaviourally based components of these programs will be described and their contribution to toilet training discussed. This study will also review the questionnaires available to assess toileting difficulties in this population, and their contribution to toilet training programs will also be reviewed.

In this study, a novel enuresis alarm device using a miniaturized radio frequency module and disposable sensors made with inexpensive conductive ink was used to teach toilet use for urination with three participants with severe intellectual disability (two males and one female; aged 7-15 years) in a private special education school setting. At study entry, the participants did not use the toilet for urination independently, despite prior training attempts using standard behavioral interventions. For each participant, the enuresis alarm was used as part of a manualized behavior modification program. Two of the participants progressed markedly in the acquisition of toileting skills during participation in the program, but results for the third participant were less clear. Data suggest high staff satisfaction with the device and procedure and several possible advantages over standard behavioral intervention. Thus, an enuresis alarm that comprises state-of-the-art technology may be useful for teaching toileting skills in classroom settings for some individuals with developmental disabilities.

We evaluated the combined and sequential effects of 3 toilet-training procedures recommended for use with young children: (a) underwear, (b) a dense sit schedule, and (c) differential reinforcement. A total of 20 children participated. Classroom teachers implemented a toilet-training package consisting of all 3 procedures with 6 children. Of the 6 children, 2 showed clear and immediate improvements in toileting performance, and 3 showed delayed improvements. Teachers implemented components of the training package sequentially with 12 children. At least 2 of the 4 children who experienced the underwear component after baseline improved. Toileting performance did not improve for any of the 8 children who were initially exposed to either the dense sit schedule or differential reinforcement. When initial training components were ineffective, teachers implemented additional components sequentially until toileting performance improved or all components were implemented. Toileting performance often improved when underwear or differential reinforcement was later added.

In Slovenia there is a unitary system of early education for all preschool-aged children. Since the vast majority of children attend full-day programmes, the daily routine represents a significant part of life for children in kindergarten. When systemic and curricular reform of preschools was introduced at the end of the twentieth century, lot of attention was paid to changing the previously rigid and non-individualised daily routine. This article presents some of the findings of a research project that introduced principles of Reggio Emilia preschools in Italy to preschool teachers in Slovenia and concerned indirectly the daily routine. The focus was on whether and in what manner the daily routine changed in the decade after the introduction of the new national curriculum, and whether the mentioned training influenced these changes. The results show increased flexibility of the daily routine in teachers' practices but the picture is not uniformly positive.

This study examined the face and preliminary content validity of the Toileting Habit Profile Questionnaire, a tool designed to screen for sensory-based defecation difficulties in children. A panel of experts reviewed a pilot version of the questionnaire and responded to probe questions. Two reviewers conducted direct content analysis of responses; 100% agreement was reached. Experts demonstrated a high degree of agreement and their input was useful in establishing this tool for initial research and clinical use. The Toileting Habit Profile Questionnaire appears to capture behaviors that are consistent with problematic toileting behaviors, particularly as they relate to sensory overreactivity.

The present study investigated the effectiveness of video hero modeling (VHM) for building four bathroom-related behaviors of an elementary-aged student with autism spectrum disorder. In the VHM intervention, the participant watched a video immediately before going to the bathroom he typically used. In the video, an animated face of a cartoon hero with which the participant was preoccupied and an adult who pretended he was the hero appeared in the bathroom. While the adult (whose head was not shown in the film) engaged in the target behavior, the animated cartoon hero explained that the adult was hero and showed how the student had to behave. A multiple baseline across behaviors demonstrated that VHM interventions contributed to improving the four target behaviors. However, for one target behavior, the video hero praising (VHP) intervention seemed necessary to evoke a correct response in a stable manner.

The purpose of this study was to determine effectiveness of a modified version of Azrin and Foxx's (1971) intensive toilet training method on teaching of toilet skills to children with autism. This method consists of administering extra fluids and a time schedule, but does not use overcorrection procedures. Implementation requires a study of six hours per day. The study was conducted with three children with autism in an educational setting and used a multiple probe design. Both inter-observer and procedural reliability data were collected. Graphical analysis was used to determine effectiveness of a modified version of Azrin and Foxx's method for teaching toilet skills to children with autism. Results of the study indicate that the modified Azrin and Foxx method was effective in teaching dryness and urinating into the toilet at acquisition level to children with autism. Parents of the research subjects were very satisfied with the results.