- When can we expect readiness and training?
The chronologic disparity between initial success and toilet mastery may be reflected in the fact that parents tend to misjudge the age at which a child completes training as well as the amount of time required for toilet training (which averages 5.8 months and 6.4 months for bladder training in females and males, respectively, and 6.3 and 6.9 months for bowel training). Source: PediatricsIt is a pleasure to read that Azrin and Foxx "provided pediatricians with additional empirical standards for tracking a child's progress toward toilet mastery" when they identified empirically two components of toilet training readiness, which they called physiologic and psychological. Physiologic markers include sphyncter control and muscle tone:
"...sufficient muscle tone to carry out the physical components of independent toileting, ie, the ability to walk from room to room, pick up small objects, get dressed and undressed, and sit upright for 5 to 10 minutes at a time."Psychological variables involve the called cognitive abilities that Foxx and Azrin described as observable behaviours:
I recommend not over worrying about the pointing to body parts! And having the child's doctor clear for toiling / investigate if there is anything medical that should be known or should be treated or considered before toilet training.
Children's maturity and mastery of such markers vary too greatly to allow a simple readiness test or guarantee that everything will go smoothly if the mentioned variable have been achieved. To complicate matters, children with autism may be "all over the place" with their maturity and skill mastery across areas of development. So we are on our own so to speak and experience will help dramatically, professional out there. And parents, you can count on experienced professionals to help.
*1 - Collect data on voids, time of the day or night, amount, fluid and food intake (what, how much, when).
*2- It is not only premature demands for toilet training that can generate an aversive history that will complicate training. Poor planning aside, even considering a good toiling plan that included information about the particular child and his/her learning history and preferences, the data collected, and so on, might need timely tweaks. In my practice the first implementation has to be supervised by the behaviour analyst because a lot of tweaking can be done right there, before they leave it to staff and parents until the next visit.
*3 - Be very vigilant about constipation. It can be immediately dangerous and even life threatening and it can cause a cycle of failure: child holds, it hurts, it hurts much more to have a bowel movement, child avoids bowel movements. Talk to your doctor about when to consider an emergency. I have worked with as little as 2 days without a bowel movement being recommended as visit to the emergency room because of a previous history.
- What methods exist for toilet training?
- Is there evidence for the Applied Behavior Analysis method?
The source article (Pediatrics) of the quote above goes on to identify disadvantages of using overcorrection, for example. There is discussion in the field about the necessity of overcorrection to the success of the behavioural method of toilet training. My opinion is that it is not necessary to include overcorrection and I have not even been involved in many toilet trainings with this component. Some concerns I have are that every individual responds differently to the contingencies, thus the usual overcorrection might not at all have a decreasing effect. What should be involved in the toiling overcorrection is not set in stone and different people choose different things; clean mess, re-do what would have been the right chain, once, twice, five times? I will not go on and on about how this does not result in practicing the appropriate behaviours under the appropriate motivation, which is essential. It is also risky that in unsupervised environments it may bring more aversiveness than necessary, such as angry disapproving faces, punishing statements, or more. I do not accept this type of treatment.
Previously in the ABA Blog: Toilet Training Readiness