The Effects of a Decision-Protocol Informed Toilet Training Intervention for Preschoolers with Disabilities

  • Madeline R. Frank
  • Ji Young Kim
  • Daniel M. FienupEmail author


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.


Preschoolers with disabilities Decision protocol Interval toilet training Rapid toilet training Toilet training 


Compliance with Ethical Standards

Ethical Approval

The school’s Institutional Review Board deemed this research as exempt educational research. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and 1964 Helsinki declaration and its later amendments or comparable ethical standard.

Informed Consent

Each participant’s parent consented to the dissemination of data collected during regular educational activities.

Conflict of Interest

All three authors claim no conflict of interest.


  1. Azrin, N. H., & Foxx, R. M. (1971). A rapid method of toilet training the institutionalized retarded. Journal of Applied Behavior Analysis, 4, 89–99.CrossRefGoogle Scholar
  2. Cocchiola, 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, 60–64.CrossRefGoogle Scholar
  3. Geiger, K. B., Carr, J. E., & LeBlanc, L. A. (2010). Function-based treatments for escape-maintained problem behavior: A treatment-selection model for practicing behavior analysts. Behavior Analysis in Practice, 3, 22–32.CrossRefGoogle Scholar
  4. Greer, D. R. (2002). Designing teaching strategies: An applied behavior analysis systems approach. San Diego: Academic Press.Google Scholar
  5. Greer, B. D., Neidert, P. L., & Dozier, C. L. (2016). A component analysis of toilet-training procedures recommended for young children. Journal of Applied Behavior Analysis, 49, 69–84.CrossRefGoogle Scholar
  6. Halliday, S., Meadow, S. R., & Berg, I. (1987). Successful management of daytime enuresis using alarm procedures: A randomly controlled trial. Archives of Disease in Childhood, 62, 132–137.CrossRefGoogle Scholar
  7. Horner, R. H., Carr, E. G., Halle, J., McGee, G., Odom, S., & Wolery, M. (2005). The use of single-subject research to identify evidence-based practice in special education. Exceptional Children, 71, 165–179.Google Scholar
  8. Ingham, P., & Greer, R. D. (1992). Changes in student and teacher responses in observed and generalized settings as a function of supervisor observations. Journal of Applied Behavior Analysis, 25, 153–164.CrossRefGoogle Scholar
  9. Keohane, D. D., & Greer, R. D. (2005). Teacher’s use of verbally governed algorithm and student learning. International Journal of Behavioral Consultation and Therapy, 1, 252–271.CrossRefGoogle Scholar
  10. Kipfmiller, K. J., Brodhead, M. T., Wolfe, K., LaLonde, K., Sipia, E. S., Savana Bak, M. Y., & Fisher, M. H. (2019). Training front-line employees to conduct visual analysis using a clinical decision-making model. Advanced online copy. Journal of Behavioral Education, 28, 301–322. Scholar
  11. 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, 607–618.CrossRefGoogle Scholar
  12. 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, 98–105.CrossRefGoogle Scholar
  13. LeBlanc, L. A., Raetz, P. B., Sellers, T. P., & Carr, J. E. (2016). A proposed model for selecting measurement procedures for the assessment and treatment of problem behavior. Behavior Analysis in Practice, 9, 77–83.CrossRefGoogle Scholar
  14. Post, A. R., & Kirkpatrick, M. A. (2004). Toilet training for a young boy with pervasive developmental disorder. Behavioral Interventions, 19, 45–50.CrossRefGoogle Scholar
  15. Shelov, S. P. (2009) Caring for your baby and young child, birth to age 5 (5th ed.). American Academy of Pediatrics. Bentham: New York.Google Scholar
  16. Vermandel, A., Weyler, J., De Wachter, S., & Wyndaele, J. J. (2008). Toilet training of healthy young toddlers: A randomized trial between a daytime wetting alarm and timed potty training. Journal of Developmental and Behavioral Pediatrics, 29, 191–196.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Health and Behavior StudiesTeachers College Columbia UniversityNew YorkUSA

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