There are several potty training procedures that have been found to be effective.  The first recommended method is referred to as graduated guidance.  Graduated guidance is a prompt based method using “behavioral chaining.”  Behavioral chaining involves reinforcing closer approximations of the behavior targeted (using the toilet).  In this procedure you begin with the least involved prompt to start the chain.  For example you may bring the child to the potty and stand there with an obvious pause, if they don’t begin the process of undressing to use the toilet then point to their pants (gesturing to pull them down), if need be you would then present a verbal prompt, and finally move on to increasing levels of physical prompting.  In the event that graduated guidance is successful there are other more involved procedures available.

         One empirically based procedure that we have been using is based on the protocol from Kimberly Kroeger and Rena Sorensen (2010).  The purpose of the procedure is to teach self initiation through a sitting schedule.  The sitting schedule is:

• 30 minutes sitting on the toilet, 5 minutes off (for successfully going)
• 25 minutes on, 10 minutes off
• 20 minutes on, 15 minutes off
• 15 minutes on, 20 minutes off
• 10 minutes on, 25 minutes off
• 5 minutes on, 30 minutes off

If the child successfully urinates/defecates on the toilet (even if there is more time on the toilet) their minutes off automatically begin, and if they go during their time off the time off restarts.  Each time they have successfully gone 3 times in a row you move down to the next sitting schedule.  Once they have reached the 20 minutes on, if they are not already self-initiating then a chair is introduced.  You begin by placing a chair 2 feet away facing the toilet and once they have successfully gone 3 times in a row you move the chair 2 feet further away from the toilet.  Once the chair is 20 feet away you start decreasing the time again.  This teaches them the sensation of their bladder being full and needing to stand up from where they are to independently go to the restroom.

            Potty training children with developmental disorders may seem overwhelming, but these two protocols have been shown through data based research to be effective methods of potty training in both neurotypical and autistic children.  With consistency, patience, and a plan toilet training will be quick and effective, and your child will benefit from the independence and comfort of being able to self-initiate.

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1)      Social Referencing: You and the child are seated across a table from one another. Place up to 10 pieces of preferred edibles in a row on the table. When the child is seated quietly and makes eye contact with you, nod your head up and down, permitting the child to take an edible. A few notes on this procedure, 1) if the child attempts to grab the candy prior to making eye contact, you should block access and 2) you may want to start by only placing one edible on the table at a time to eliminate distractions.

2)       Establishing gaze- or point-following: Again, you and the child are seated across the table from one another. You will need 2 opaque cups and up to 10 pieces of a preferred edible that will fit underneath the cup. With both cups upside down on the table, have the child close his/her eyes and when he/she is not looking, place an edible under 1 of the 2 cups. Tell the child, “Ready,” or “You can look now”. Once the child makes eye contact, immediately move your face as close to the cup with the hidden treat. The child should select the cup that you are closest to. If not, do not allow access to edible, repeat the trial until the child consistently (3 consecutive trials) looks at your face and selects the correct cup.

These are only a few of the procedures that we use to help enhance joint attention skills.  Other simple steps could include, reinforcing any eye contact made at any time, delaying access to preferred items until eye contact is made. One way to increase the success of these steps is to ensure that the item is highly preferred/desired. When not naturally developed, eye contact is a skill that can be taught and strengthened through a history of reinforcement. Like any learned skill, it takes time, patience, and consistency.

References

Holth, Per.  (2006).  An Operant Analysis of Joint Attention Skills. European Journal of      Behavior Analysis, 7, 77-91

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