Skip to main content

Advertisement

Log in

The Assessment and Treatment of Toileting Difficulties in Individuals with Autism Spectrum Disorder and Other Developmental Disabilities

  • Review Paper
  • Published:
Review Journal of Autism and Developmental Disorders Aims and scope Submit manuscript

Abstract

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  • Ando, H., Yoshimura, I., & Wakabayashi, S. (1980). Effects of age on adaptive behavior levels and academic skill levels in autistic and mentally retarded children. Journal of Autism and Developmental Disorders, 10(2), 173–184.

    Article  PubMed  Google Scholar 

  • Ardiç, A., & Cavkaytar, A. (2014). Effectiveness of the modified intensive toilet training method on teaching toilet skills to children with autism. Education and Training in Autism and Developmental Disabilities, 49(2), 263.

    Google Scholar 

  • Axelrod, M. I., Tornehl, M., & Fontanini-Axelrod, A. (2016). Co-occurring autism and intellectual disability: a treatment for encopresis using a behavioral intervention plus laxative across settings. Clinical Practice in Pediatric Psychology, 4(1), 1.

    Article  Google Scholar 

  • Azrin, N. H., & Foxx, R. M. (1971). A rapid method of toilet training the institutionalized retarded. Journal of Applied Behavior Analysis, 4(2), 89–99.

    Article  PubMed  PubMed Central  Google Scholar 

  • Bailey Jr., D. B., Raspa, M., Holiday, D., Bishop, E., & Olmsted, M. (2009). Functional skills of individuals with fragile X syndrome: a lifespan cross-sectional analysis. American Journal of Intellectual and Developmental Disabilities, 114(4), 289–303.

    Article  Google Scholar 

  • Bainbridge, N., & Myles, B. S. (1999). The use of priming to introduce toilet training to a child with autism. Focus on Autism and Other Developmental Disabilities, 14(2), 106–109.

    Article  Google Scholar 

  • Beetz, R., Von Gontard, A., & Lettgen, B. (1994). Anamnese-Fragebogen: Einnässen/Harninkontinenz und Erläuterungen zum Anamnese-Fragebogen. Bad Homburg: Enuresis Informationszentrum.

  • Belva, B., Matson, J. L., Barker, A., Shoemaker, M. E., & Mahan, S. (2011). The relationship between adaptive behavior and specific toileting problems according to the profile on toileting issues (POTI). Journal of Developmental and Physical Disabilities, 23(6), 535–542.

    Article  Google Scholar 

  • Brown, F. J., & Peace, N. (2011). Teaching a child with challenging behaviour to use the toilet: a clinical case study. British Journal of Learning Disabilities, 39(4), 321–326.

    Article  Google Scholar 

  • Bruininks, R. H., Bradley, H. K., Weatherman, R. F., & Woodcock, R. W. (1996). SIB-R. Riverside publishing Company.

  • Butler, J. F. (1976). The toilet training success of parents after reading toilet training in less than a day. Behavior Therapy, 7(2), 185–191.

    Article  Google Scholar 

  • Chang, Y. J., Lee, M. Y., Chou, L. D., Chen, S. F., & Chen, Y. C. (2011). A mobile wetness detection system enabling teachers to toilet train children with intellectual disabilities in a public school setting. Journal of Developmental and Physical Disabilities, 23(6), 527–533.

    Article  Google Scholar 

  • Chung, K. M. (2007). Modified version of Azrin and Foxx’s rapid toilet training. Journal of Developmental and Physical Disabilities, 19(5), 449–455.

    Article  Google Scholar 

  • Cicero, F. R., & Pfadt, A. (2002). Investigation of a reinforcement-based toilet training procedure for children with autism. Research in Developmental Disabilities, 23(5), 319–331.

    Article  PubMed  Google Scholar 

  • Cocchiola Jr., M. A., Martino, G. M., Dwyer, L. J., & Demezzo, K. (2012). Toilet training children with autism and developmental delays: an effective program for school settings. Behavior Analysis in Practice, 5(2), 60.

    Article  PubMed  PubMed Central  Google Scholar 

  • Cooper, S. A., Smiley, E., Morrison, J., Williamson, A., & Allan, L. (2007). Mental ill-health in adults with intellectual disabilities: prevalence and associated factors. The British Journal of Psychiatry, 190(1), 27–35.

    Article  PubMed  Google Scholar 

  • Cooper, S. A., Smiley, E., Jackson, A., Finlayson, J., Allan, L., Mantry, D., & Morrison, J. (2009). Adults with intellectual disabilities: prevalence, incidence and remission of aggressive behaviour and related factors. Journal of Intellectual Disability Research, 53(3), 217–232.

    Article  PubMed  Google Scholar 

  • Croen, L. A., Grether, J. K., Hoogstrate, J., & Selvin, S. (2002). The changing prevalence of autism in California. Journal of Autism and Developmental Disorders, 32(3), 207–215.

    Article  PubMed  Google Scholar 

  • Dalrymple, N. J., & Ruble, L. A. (1992). Toilet training and behaviors of people with autism: parent views. Journal of Autism and Developmental Disorders, 22(2), 265–275.

    Article  PubMed  Google Scholar 

  • Didden, R., Sikkema, S. P., Bosman, I., Duker, P. C., & Curfs, L. M. (2001). Use of a modified Azrin–Foxx toilet training procedure with individuals with Angelman syndrome. Journal of Applied Research in Intellectual Disabilities, 14(1), 64–70.

    Article  Google Scholar 

  • Drysdale, B., Lee, C. Y. Q., Anderson, A., & Moore, D. W. (2015). Using video modeling incorporating animation to teach toileting to two children with autism spectrum disorder. Journal of Developmental and Physical Disabilities, 27(2), 149–165.

    Article  Google Scholar 

  • Duker, P. C., & Dekkers, M. (1992). Development of diurnal bladder control in severely and profoundly mentally handicapped residents. Journal of Intellectual Disability Research, 36(2), 177–181.

    Article  PubMed  Google Scholar 

  • Dykens, E. M., Hodapp, R. M., & Leckman, J. F. (1989). Adaptive and maladaptive functioning of institutionalized and noninstitutionalized fragile X males. Journal of the American Academy of Child & Adolescent Psychiatry, 28(3), 427–430.

    Article  Google Scholar 

  • Equit, M., Piro-Hussong, A., Niemczyk, J., Curfs, L., & von Gontard, A. (2013). Elimination disorders in persons with Prader–Willi and Fragile-X syndromes. Neurourology and Urodynamics, 32(7), 986–992.

    Article  PubMed  Google Scholar 

  • Foxx, R. M., & Azrin, N. H.(1973). Dry pants: A rapid method of toilet training children. Behaviour Research and Therapy, 11(4), 435–442.

  • Giesbers, S., Didden, R., Radstaake, M., Korzilius, H., von Gontard, A., Lang, R., et al. (2012). Incontinence in individuals with Rett syndrome: a comparative study. Journal of Developmental and Physical Disabilities, 24(3), 287–300.

    Article  PubMed  PubMed Central  Google Scholar 

  • Henriksen, N., & Peterson, S. (2013). Behavioral treatment of bedwetting in an adolescent with autism. Journal of Developmental and Physical Disabilities, 25(3), 313–323.

    Article  Google Scholar 

  • Joinson, C., Heron, J., Butler, R., Von Gontard, A., Butler, U., Emond, A., & Golding, J. (2007). A United Kingdom population-based study of intellectual capacities in children with and without soiling, daytime wetting, and bed-wetting. Pediatrics, 120(2), 308–316.

    Article  Google Scholar 

  • Keen, D., Brannigan, K. L., & Cuskelly, M. (2007). Toilet training for children with autism: the effects of video modeling. Journal of Developmental and Physical Disabilities, 19(4), 291–303.

    Article  Google Scholar 

  • Kroeger, K., & Sorensen, R. (2010). A parent training model for toilet training children with autism. Journal of Intellectual Disability Research, 54(6), 556–567.

    Article  PubMed  Google Scholar 

  • Kroeger, K. A., & Sorensen-Burnworth, R. (2009). Toilet training individuals with autism and other developmental disabilities: a critical review. Research in Autism Spectrum Disorders, 3(3), 607–618.

    Article  Google Scholar 

  • Lancioni, G. E., & Markus, S. (1999). Urine-triggered alarm signals and prompts to promote daytime urinary continence in a boy with severe intellectual disability. Behavioural and Cognitive Psychotherapy, 27(03), 261–265.

    Google Scholar 

  • Lancioni, G. E., O'Reilly, M. F., Serenelli, S., & Campodonico, F. (2000). Alarm signals and prompts to eliminate large urinary accidents in a woman with multiple disabilities. Scandinavian Journal of Behaviour Therapy, 29(3–4), 152–155.

    Article  Google Scholar 

  • LeBlanc, L. A., Carr, J. E., Crossett, S. E., Bennett, C. M., & Detweiler, D. D. (2005). Intensive outpatient behavioral treatment of primary urinary incontinence of children with autism. Focus on Autism and Other Developmental Disabilities, 20(2), 98–105.

    Article  Google Scholar 

  • Lee, C. Y. Q., Anderson, A., & Moore, D. W. (2014). Using video modeling to toilet train a child with autism. Journal of Developmental and Physical Disabilities, 26(2), 123–134.

    Article  Google Scholar 

  • Lohmann, W., Eyman, R. K., & Lask, E. (1967). Toilet training. American Journal of Mental Deficiency, 71(4), 551.

    PubMed  Google Scholar 

  • Lott, J. D., & Kroeger, K. A. (2004). Self-help skills in persons with mental retardation. In J. L. Matson, R. B. Laud, & M. L. Matson (Eds.), Behavior modification for persons with developmental disabilities: treatment and supports (Vol. Vol II). New York: National Association for the Dually Diagnosed.

    Google Scholar 

  • Lovering, J. S., Tallett, S. E., & McKendry, J. B. (1988). Oxybutynin efficacy in the treatment of primary enuresis. Pediatrics, 82(1), 104–106.

  • Luiselli, J. K. (1997). Teaching toilet skills in a public school setting to a child with pervasive developmental disorder. Journal of Behavior Therapy and Experimental Psychiatry, 28(2), 163–168.

    Article  PubMed  Google Scholar 

  • Luiselli, J. K. (2007). Single-case evaluation of a negative reinforcement toilet training intervention. Child & Family Behavior Therapy, 29(1), 59–69.

    Article  Google Scholar 

  • Mannion, A., & Leader, G. (2013). Comorbidity in autism spectrum disorder: a literature review. Research in Autism Spectrum Disorders, 7(12), 1595–1616.

    Article  Google Scholar 

  • Mantry, D., Cooper, S. A., Smiley, E., Morrison, J., Allan, L., Williamson, A., et al. (2008). The prevalence and incidence of mental ill-health in adults with down syndrome. Journal of Intellectual Disability Research, 52(2), 141–155.

    PubMed  Google Scholar 

  • Maskey, M., Warnell, F., Parr, J. R., Le Couteur, A., & McConachie, H. (2013). Emotional and behavioural problems in children with autism spectrum disorder. Journal of Autism and Developmental Disorders, 43(4), 851–859.

    Article  PubMed  Google Scholar 

  • Matson, J. L. (1988). Teaching and training relevant community skills to mentally retarded persons. Child & Youth Services, 10(2), 105–121.

  • Matson, J. L., & LoVullo, S. V. (2009). Encopresis, soiling and constipation in children and adults with developmental disability. Research in Developmental Disabilities, 30(4), 799–807.

    Article  PubMed  Google Scholar 

  • Matson, J. L., & Shoemaker, M. E. (2011). Psychopathology and intellectual disability. Current Opinion in Psychiatry, 24(5), 367–371.

    Article  PubMed  Google Scholar 

  • Matson, J. L., Dempsey, T., & Fodstad, J. C. (2010). The profile of toileting issues (POTI). Baton Rouge: Disability Consultants, LLC.

    Google Scholar 

  • Matson, J. L., Horovitz, M., & Sipes, M. (2011a). Characteristics of individuals with toileting problems and intellectual disability using the profile of toileting issues (POTI). Journal of Mental Health Research in Intellectual Disabilities, 4(1), 53–63.

    Article  Google Scholar 

  • Matson, J. L., Neal, D., Hess, J. A., & Kozlowski, A. M. (2011b). Assessment of toileting difficulties in adults with intellectual disabilities: an examination using the profile of toileting issues (POTI). Research in Developmental Disabilities, 32(1), 176–179.

    Article  PubMed  Google Scholar 

  • McLay, L., Carnett, A., van der Meer, L., & Lang, R. (2015). Using a video modeling-based intervention package to toilet train two children with autism. Journal of Developmental and Physical Disabilities, 1–21.

  • Mowrer, O. H., & Mowrer, W. M. (1938). Enuresis—A method for its study and treatment. American Journal of Orthopsychiatry, 8(3), 436.

    Article  Google Scholar 

  • Ohtake, Y., Takahashi, A., & Watanabe, K. (2015). Using an animated cartoon hero in video instruction to improve bathroom-related skills of a student with autism spectrum disorder. Education and Training in Autism and Developmental Disabilities, 50(3), 343–355.

    Google Scholar 

  • Oliver, C., & Richards, C. (2010). Self-injurious behaviour in people with intellectual disability. Current Opinion in Psychiatry, 23(5), 412–416.

    Article  PubMed  Google Scholar 

  • Ozcan, N., & Cavkaytar, A. (2009). Parents as teachers: teaching parents how to teach toilet skills to their children with autism and mental retardation. Education and Training in Developmental Disabilities, 237–243.

  • Radstaake, M., Didden, R., Giesbers, S., Korzilius, H., Peters-Scheffer, N., Lang, R., et al. (2013). Incontinence in individuals with Angelman syndrome: a comparative study. Research in Developmental Disabilities, 34(11), 4184–4193.

    Article  PubMed  Google Scholar 

  • Rinald, K., & Mirenda, P. (2012). Effectiveness of a modified rapid toilet training workshop for parents of children with developmental disabilities. Research in Developmental Disabilities, 33(3), 933–943.

    Article  PubMed  Google Scholar 

  • Sattler, J. M. (2002). Assessment of children: behavioral and clinical applications. San Diego: Jerome M. Sattler, Publisher.

  • Schum, T. R., Kolb, T. M., McAuliffe, T. L., Simms, M. D., Underhill, R. L., & Lewis, M. (2002). Sequential acquisition of toilet-training skills: a descriptive study of gender and age differences in normal children. Pediatrics, 109(3), 48.

    Article  Google Scholar 

  • Smiley, E., Cooper, S. A., Finlayson, J., Jackson, A., Allan, L., Mantry, D., et al. (2007). Incidence and predictors of mental ill-health in adults with intellectual disabilities. The British Journal of Psychiatry, 191(4), 313–319.

    Article  PubMed  Google Scholar 

  • Smith, P. S., & Smith, L. J. (1977). Chronological age and social age as factors in intensive daytime toilet training of institutionalized mentally retarded individuals. Journal of Behavior Therapy and Experimental Psychiatry, 8(3), 269–273.

    Article  Google Scholar 

  • Sparrow, S. S., Balla, D. A., Cicchetti, D. V., & Doll, E. A. (1984). Vineland adaptive behavior scales: survey form manual. American Guidance Service.

  • Sparrow, S. S., Cicchetti, D. V., & Balla, D. A. (2005). Vineland adaptive behaviour scales (2nd ed.). Circle Pines, MN: American Guidance Service.

    Google Scholar 

  • Strauss, D., & Zigman, W. B. (1996). Behavioral capabilities and mortality risk in adults with and without down syndrome. American Journal on Mental Retardation, 101(3), 269–281.

    PubMed  Google Scholar 

  • Suppo, J. L., & Mayton, M. R. (2012). A portable potty plan for children with autism. Young Exceptional Children, 1096250612451758.

  • Szyndler, J. (1996). Toileting problems in a group of children with autism. Child Psychology and Psychiatry Review, 1(1), 19–25.

    Article  Google Scholar 

  • Thomson, K., Walters, K., Martin, G. L., & Yu, C. T. (2011). Teaching adaptive and social skills to individuals with Autism Spectrum Disorders. In International Handbook of Autism and Pervasive Developmental Disorders (pp. 339–354). Springer: New York.

  • UCEDD, G. (2001). The C21st health check. Glasgow: University of Glasgow.

    Google Scholar 

  • Van Laecke, E., Hoebeke, P., Raes, A., Klockaerts, K., & Walle, J. V. (2008). Adequate fluid intake, an important factor in the treatment of urinary incontinence in children suffering mental and/or motor disability. Journal of Pediatric Urology, 4, S37.

    Article  Google Scholar 

  • Van Oorsouw, W. M., Duker, P. C., Melein, L., & Averink, M. (2009). Long-term effectiveness of the response restriction method for establishing diurnal bladder control. Research in Developmental Disabilities, 30(6), 1388–1393.

    Article  PubMed  Google Scholar 

  • Vermandel, A., Van Kampen, M., Van Gorp, C., & Wyndaele, J. (2007). How to toilet train healthy children? A review of the literature. Neurology and Urodynamics, 27, 162–166.

    Article  Google Scholar 

  • Vermandel, A., Van Kampen, M., De Wachter, S., Weyler, J., & Wyndaele, J. J. (2009). The efficacy of a wetting alarm diaper for toilet training of young healthy children in a day-care center: A randomized control trial. Neurourology and urodynamics, 28(4), 305–308.

  • Von Gontard, A., Didden, R., Sinnema, M., & Curfs, L. (2010). Urinary incontinence in persons with Prader-Willi syndrome. BJU International, 106(11), 1758–1762.

    Article  PubMed  Google Scholar 

  • Wells, K., Condillac, R., Perry, A., & Factor, D. C. (2009). A comparison of three adaptive behaviour measures in relation to cognitive level and severity of autism. J Dev Disabil, 15, 55–63.

  • Williams, F. E., & Sloop, E. W. (1978). Success with a shortened Foxx-Azrin toilet training program. Education and Training of the Mentally Retarded, 399–402.

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Geraldine Leader.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Francis, K., Mannion, A. & Leader, G. The Assessment and Treatment of Toileting Difficulties in Individuals with Autism Spectrum Disorder and Other Developmental Disabilities. Rev J Autism Dev Disord 4, 190–204 (2017). https://doi.org/10.1007/s40489-017-0107-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40489-017-0107-3

Keywords

Navigation