Toilet training has been a topic of research for decades (Mower, O.H. and Mowrer, 1938) and remains an area of interest for parents and clinicians.
One frequently cited reference on this topic has lead to variations and replications in subsequent research (Azrin, N. H. & Foxx, R. M. 1971, Journal of Applied Behavior Analysis).
In 2010, Dr. Patrick Friman published an article in The Behavior Analyst and identified related areas of medical practice that could be addressed by behavior analysts. In the article, he provides a table of Parent-ranked behavior problems in 3-year-old children wherein the number one problem is incontinence. (Friman, P. C., (1971) The Behavior Analyst, 2010, p.21)
A review by Kroeger & Sorensen-Burnworth of toilet training research addresses several programs related to two publications by (Azrin, N. H., & Foxx, R. M. (1971), A rapid method of toilet training the institutionalized retarded. Journal of Applied Behavior Analysis, 4, 89–99 and Azrin, N.H., & Foxx, R. M. (1974) and Toilet training in less than a day. (New York: Simon & Schuster). Copyright 2009 Elsevier Ltd. All rights reserved.
One issue of interest cited was manipulation of stimulus control (Kroeger, K.A. & Sorensen-Burnworth, Toilet training individuals with autism and other developmental disabilities: A critical review. Research in Autism Spectrum Disorders (2009).
There are four articles in this CEU. Each article’s specific objectives are presented in as a “study guide” derived from the readings. The first article in this CEU, A Stimulus Control Technique for Improving the Efficacy of An Established Toilet Training Program identifies a stimulus control approach by Taylor, S., Cipani, E., and Clardy S. (1994).
The second article, Successful use of the nocturnal urine alarm for diurnal enuresis, addresses one of the methods identified in A rapid method of toilet training the institutionalized retarded, the original Azrin and Foxx 1971 article.
The third article, Extended diaper wearing: Effects on continence in and out of the diaper, Tarbox, Williams and Friman (2004) addresses the results of the presence and absence of diaper wearing.
The fourth and final article, The effects of undergarment type on the urinary continence of toddlers, Simon and Thompson (2006).
These four examples of research and strategies for toilet training provide information for your consideration as you conduct relevant assessments for clients and hopefully reveal some aspects you might consider for inclusion in your own programs for helping clients develop continence to improve their own lives and benefit those involved in the client’s life.
Following the last article, we will present another brief discussion to address the articles and their contribution to the habilitative process of toilet training.
The CEU will conclude with a required evaluation which helps us learn and improve our efforts to provide helpful and meaningful continuing education units.
The same year as the JABA article was published, Azrin and Foxx also published a well-received book by Simon and Shuster (1974) has reportedly sold more than 2 million copies. This book has been the basis for a number of research investigations.