Chapter 7

• Describe how parents get information on toilet training approaches and discuss how these sources of information may impact their views on toileting.
• Discuss procedures that may be useful for determining toileting readiness.
• List the steps involved in a general approach to toilet training and discuss how each of these steps may be individualized to meet the specific needs of different children.

1. Window of best opportunity The time frame for suggested toileting training which is between two years and three years of age.
2. Urinary incontinence This involves releasing urine at inappropriate times or places. Bowel incontinence is the same except with bowel movements.
3. Enuresis This is urinary incontinence occurring after age five and that is not the result of some physical, structural, or medical condition. There are two types. Diurnal enuresis refers to wetting that occurs during the daytime. Nocturnal enuresis refers to wetting that occurs at nighttime and is frequently referred to as bedwetting.
4. Encopresis This is another term for bowel incontinence, although this term is frequently reserved for bowel incontinence occurring after age four and that is not the result of some physical, structural, or medical condition.
5. Fecal impaction This is a condition where feces/stool become lodged in the colon. This condition can cause the colon to become enlarged and may be uncomfortable or even painful and result in constipation or diarrhea.
6. Paradoxical diarrhea This refers to passage of very wet stool when a fecal impaction is present. Although a fecal impaction of hard stool may remain in place, very wet stool is able to move around an impaction and be expelled from the body.

www.nursingtimes.net/Journals/2014/10/17/a/m/u/141022Toileting-problems-in-children-with-autism.pdf

www.minddisorders.com/Del-Fi/Elimination-disorders.html

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

Mellon, M. W., Natchev, B. E., Katusic, S. K., Colligan, R. C., Weaver, A. L., Voigt, R. G., et al. (2013). Incidence of enuresis and encopresis among children with attention-deficit/hyperactivity disorder in a population-based birth cohort. Academic Pediatrics, 13(4), 322–327.

Smith, T. (2014). Field report: making toilet training easier—a novel enuresis alarm system. Behavior Analysis in Practice, 7, 31–32.

 

This chapter focused on the importance of recognizing toileting readiness skills, reinforcing pre-toileting behaviors, and providing a supportive environment for successful toileting. A basic toileting instructional sequence was described for parent implementation, which could be modified for continuity of procedures from home to daycare setting. In addition, terminology associated with toileting and elimination issues was defined and some common elimination disorders were described. A highly effective treatment for enuresis, the urine alarm, was described, and a combined medical and behavior analytic treatment for encopresis was described.