Cindy Myers
Comprehensive Behavior Specialist cindy.myers@slc.k12.ut.us

• Students with a variety of physical disabilities including cerebral palsy
• Students who use wheelchairs for mobility
• Students who are verbal or non-verbal

• Students on Neurogenic bowel & bladder programs
• Check with doctor before considering students with spinal cord injuries
– Paraplegia, quadriplegia, spina bifida

•Maintains dry diaper for ½ hour or more
•Age over 4 ½
•Displays no fear of being in, on, or around the bathroom or toilet
•Communication system in place

• Consultation with physical therapist:
– Positioning
– Transition to the toilet
– Weight bearing
– Adaptive equipment issues
– Issues specific to the student
• Address issues before beginning!

• Track the child’s natural schedule of elimination
• “Predict” the time episodes of elimination are likely and toilet the child around those times
• Use of positive reinforcement
• No punishment component
• Training occurs in the classroom and is then generalized or trained in the home
• Minimizes stress to families & caregivers for training responsibility

• Uses consistent “signals” or communication mands to develop relationships between action & consequences
• Uses routines and environmental S
D to elicit appropriate toileting response

• Task analyze the steps involved for that student to “toilet”
• Develop a routine or procedures to be followed in a consistent manner each time the student is toileted
• Standardize presentation of environmental or artificial stimuli that will be used as S
D for steps in the toileting chain.

• Evaluate the communication needs of the student
– Consult with a SLP if appropriate
• Make a list of vocabulary, mands, or signals that are associated with all tasks around toileting
– Moving from work area to toilet
– Lifting, carrying
– Undressing/dressing
– Urination, defecation
– “finished”
– Hygiene

• Review and understand each procedure in the training protocol
• Schedule a meeting to present your plan to the student’s parents
• Provide a copy of the protocol for parents to keep
• Ask parents to contact the student’s physician regarding medical feasibility of toilet training
• Modifying the student’s IEP to include a toilet training goal

• Obtain written permission
• Agree on a starting and review date
• Discuss terminology that will be used
• Agree on signals & communication mands that will be used (if applicable)
• Provide parents with a materials list of items you want them to supply

Vocabulary List for Toileting
Urination: __________________________________
Defecation: _________________________________
Toilet: _____________________________________
Body Parts: _________________________________
Other: _____________________________________
Communication Mands/Cues
Lifting: _____________________________________
Up/down: ___________________________________
Toilet: ______________________________________
Other: ______________________________________
Other: ______________________________________
Other: ______________________________________

Permission for Toilet Training
I give permission for my child, ______________________ to participate in the schedule based toilet training procedures described in this document. I know of no medical or physical reason that would preclude toilet training for my child. I have discussed toilet training with my physician.
______________________________________ parent signature
_______________ date
_______________________________________ teacher signature
_________________ date
_______________________________________ __________________ principal/administrator signature date
________________________________________ __________________ physician signature (if applicable) date

• Consider
– Potty chair, commode, adaptations to regular toilet
– Seat/safety belts
– Positioning
– Head, truck support
– Wall bars
– Transition to/from toilet
– Issues specific to the student
• Seizures, spasticity, etc.

• Diapers, wipes, disposable gloves
• Highly desired reinforcer to be used only to R+ appropriate toileting
• Items to entertain student as s/he sits on the toilet
• Items recommended by the physical therapist unique to the student (neck brace, foam pads, etc.)
• Data sheets, clipboard, pen or pencil
• Timer

• Baseline Data
– Data Sheet 1
• Collect baseline data and develop a high probability toileting schedule
– Mark data at ½ hour intervals
– Indicate if diaper is (D) Dry, (W) Wet, or (S) Soiled
• Look for:
– Trends or patterns of dry diapers
– Trends or patterns in time or urination/defecation

• Program Data
• Data Sheet 2
– Determine schedule of high probability times that elimination is likely to occur
• Indicate if diaper is (D) Dry, (W) Wet, or (S) Soiled when taken to the toilet
• Indicate if student (U) Urinated, (BM) Bowel Movement, or
(O) No Production while on the toilet
– Review data to confirm accuracy of high probability schedule

• Place student on toilet at times indicated by the high probability schedule
• Use consistent routines and communication mands associated with toileting
• Use techniques for transfer as identified by the physical therapist

• Reinforce student with social praise paired with the highly desired reinforcer
• Immediately remove student form toilet
(using identified communication mands) and put in a clean diaper
• Return student to regular programming
• Mark data sheet
• Place student on toilet at the next “high probability” time

• Leave student on the toilet for 15 minutes
• Remove student from the toilet after 15 minutes
(using appropriate communication mands) and put in a clean diaper
• Return student to regular class routine
• Wait ½ hour and place student on the toilet again (using appropriate communication mands) for 15 minutes of toilet sitting
• Repeat ½ hour intervals until elimination occurs
(either on the toilet or in the diaper)
• Return to the original “high probability” schedule

• Give informational feedback (use designated mands if appropriate) “Your pants are wet, you need to use the toilet”
• Place student on the toilet for 15 minutes of toilet sitting
• If elimination occurs on the toilet, treat as a toilet success and R+
• Remove student from the toilet after elimination or 15 minutes, whichever happens first

•Place in a clean diaper using communication mands and routines
•Return student to regular programming and mark data sheet
•Continue with original “high probability” toileting schedule

• When the student is successfully urinating on the toilet >75%, generalization to the home should occur
• Meet with parents to discuss progress at school
• Discuss what adaptations would be necessary for toileting to occur at home
• Help parents locate resources, equipment for use at home

• Provide parents with a data sheet to track
½ hour intervals of wet/dry at home
• Meet again and review baseline data and establish a “high probability” schedule
• To assist parents in tracking wet/dry
– May have to check at hourly intervals
– May have to check at ½ hour intervals for a predetermined period of time (2 hours)

• Parents toilet student based on the high probability schedule
• Parents place student on toilet for 15 minutes of toilet sitting (using appropriate communication mands associated with the toileting routine)
• Parents R+ successful elimination on the toilet with social R+ paired with highly desired R+
• Place student in clean diaper and return to normal activities

• If accident occurs, give informational feedback. Clean student then place on toilet for 15 minutes of toilet sitting
(using communication mands).
– If elimination occurs while toilet sitting, treat as a success an R+
• Place student in clean diaper, return to regular activity
(using communication mands), and continue with high probability schedule
• Use highly desired reinforcer for successful toileting only
• Students should continue to wear diaper between toilet trips and at night until toilet use is well established