Toilet Training

The long-term goal of toilet training is a pivotal part of childhood development and a key component of independence later on in life. It can be challenging for all children to master the short-term goals (urinating inside the toilet when prompted; learning to request a visit to the bathroom; pulling pants down and up; pulling underwear down and up; wiping after using the toilet; and washing hands) that build towards mastering the long-term goal of toilet training. However, some characteristics associated with ASD can make it even more difficult for your child to successfully navigate toilet training.

The following strategies may help your child make progress towards the long-term goal of toilet training:

• Stay positive or neutral. Studies have shown that it is important for adults working with children on toilet skills to maintain a positive or neutral voice throughout toilet training, even when dealing with accidents. So keep this in mind as you work through toilet training with your child, and remember to keep your emotions in check even if you’re feeling frustrated. 
• Understand the process and parts of toilet training. Mastering the long-term goal of toilet training is a process, and it is important for you to appreciate the short-term goals that will help your child work towards mastering that long-term goal. Your child may successfully master a few short-term goals initially, but may struggle with additional short-term goals. In many cases, bowel training is accomplished naturally simultaneously alongside urination training. However, in some cases children with ASD struggle with bowel training even while successfully accomplishing urination training. In these instances, it is important to determine the underlying cause. Some causes might include medical issues, noncompliance, skill deficits, adherence to a ritual or routine, fear of eliminating in the toilet, and using bowel “accidents” to serve some other function. If you find that your child is having issues with bowel training alongside urination training, collecting data is a good first step in determining the underlying cause of your child’s issues with bowel training, and will help you determine next steps.
• Break down the process into smaller steps (e.g., task analysis). Smaller steps can sometimes help children with ASD manage a complex process like toilet training. For example, you might break down the long-term goal of toilet training into the following short-term goals: 1) Prompting to the toilet on a schedule; 2) Requesting to visit the bathroom and/or use the toilet; 3) Pulling pants off and on; 4) Pulling underwear off and on; 5) Voiding in the toilet; 6) Wiping self after using the toilet; 7) Washing hands; 8) Remaining dry. Then, you can pick a specific target for each of the short-term goals and break that down even further. For example, for the short-term goal of pulling off and pulling on pants, you might pick the target of “pulling off pants while standing.” Use positive reinforcement to encourage your child to learn to master short-term goals as they work up to mastering the long-term goal: offer a piece of candy, a small toy, etc. Once your child can manage a specific short-term goal, add another one, until they learn to use the toilet by themselves. Reward successful mastery of independent short-term goals as well as mastery of the long-term goal. If the reinforcer for the behavior is a tangible item, such as a small snack or a token for a token board, ensure that it is provided with a great deal of verbal praise. Ideally, you want your child’s positive behaviors to be supported solely by social reinforcement. Phase out the positive reinforcement when the skill has been sufficiently acquired.
• Be prepared with necessary items. In addition to understanding the process involved with the long-term goal of toilet training and preparing yourself and your child emotionally for this process, you will also need to make sure you have the physical items necessary to support your child and yourself. The checklist below is a sample place to start, and you can customize/change it to the needs of you and your child. You can customize the list depending on the age of your child, their sensory issues, and their independence levels. 

• Floor potty
• Toilet seat insert or built-in toilet seat on your regular toilet
• Foot stool, squatty potty, or ladder step stool
• Training underwear and/or pull ups
• Wipes
• Timer or watch
• Waterproof mattress protector
• Disposable absorbent pads
• Reward chart

• Teach your child how to communicate their needs using accurate language. It is important to teach your child accurate words to describe what they need in the context of toilet training, including words for their body parts, urine, and bowel movements. If your child is nonverbal, you can use a sign or gesture to signify these things instead. There are several reasons why it is important for children to be able to use the proper names for body parts, including private parts, instead of cutesy nicknames. Having the correct language helps children communicate accurately about their bodies. This is especially important for health and safety reasons, so that children can accurately tell doctors or caregivers where something hurts or itches. Using accurate terms also better prepares your child to talk confidently about changes they may experience to their body as they grow, especially to doctors, caregivers, or in settings where they may be learning about their health.
• Quickly prompt your child to the toilet at the start of an accident. Accidents are a natural and standard part of the toilet training process and an important part of helping children learn when they should be requesting to use the bathroom. Without an accident correction component, your toilet training plan will not be effective. If your child begins urinating away from the toilet, use a quick verbal prompting statement to stop your child urinating, move them to the toilet, and then encourage them to continue urinating there.
• Make it fun. Consider using a song, book, or video (see below) to help your child understand the process of going to the toilet, or the specific short-term goal they might be working on, as part of the process. Your child is more likely to cooperate if they perceive the activity as a game or something fun. Increase the rewards to speed up the process. Use positive reinforcement when your child has success at any point in the process. The positive reinforcement should be an age and effort appropriate reward: a cool sticker, a piece of candy, a small toy, an extra bedtime story, extra videogame time, etc. Phase out the positive reinforcement when the skill has been sufficiently acquired. If the reinforcer for the behavior is a tangible item, such as a small snack or a token for a token board, ensure that it is provided with a great deal of verbal praise. Ideally, you want your child’s positive behaviors to be supported solely by social reinforcement. 

Pirate Pete's Potty | Potty Training Video For Toddlers | Story Time - YouTube

Sitting On The Potty | Kids Songs | Super Simple Songs - YouTube

Potty Training Song | CoComelon Nursery Rhymes & Kids Songs - YouTube

A Potty for Me!: Katz, Karen, Katz, Karen: 9780689874239: Amazon.com: Books

Dinosaur vs. the Potty (A Dinosaur vs. Book, 2): Shea, Bob, Shea, Bob: 9781423151791: Amazon.com: Books

For the short-term goal of prompting to the toilet on a schedule, you can choose a target such as sitting on the toilet and trying to urinate within 5 minutes when prompted, sitting on the toilet and trying to urinate within 2 minutes when prompted, or sitting on the toilet and trying to urinate within 1 minute when prompted. 

Note: prompting your child to visit the toilet should happen no more frequently than every 30 minutes. Prompting your child to visit the bathroom more frequently than every 30 minutes (i.e., every 15 minutes, every 10 minutes, etc.) will not allow for periodic accidents, which are a necessary part of the toilet training process.

Sitting on the Toilet While Trying to Urinate

Once your child can successfully visit the bathroom when prompted, you can begin asking them to sit on the toilet and try to urinate when prompted. 

Step 1: Select the amount of time you want your child to practice sitting on the toilet while trying to urinate when prompted. For example, you can choose the target of sitting on the toilet while trying to urinate within 1 minute when prompted while working on the short-term goal of sitting on the toilet and trying to urinate when prompted.

Step 2: An initial/specific discriminative stimulus (SD) should be selected that will cue your child that the task must start. This SD can be a picture (i.e., a picture of a person/child sitting on the toilet) or a verbal SD such as, “Let’s sit on the toilet and try to pee,” or, “Let’s pee in the toilet!”

Step 3: Collect baseline level data by providing the SD from Step 2 and allowing your child to attempt independently. The baseline level will vary according to your child and their specific abilities. As an example, you can count how many times your child is able to sit on the toilet and attempt to urinate within 1 minute independently in a given time interval (e.g., 1 hour, 2 hours, 4 hours, etc.). As another example, you can count how many times in a row your child can sit on the toilet and attempt to urinate within 1 minute independently when prompted. 

Step 4: To begin the trial to monitor progress towards meeting the target (i.e., the target of sitting on the toilet while trying to urinate within 1 minute), provide the SD from Step 2 and allow your child to attempt independently. When your child is successful, provide reinforcement. Be generous with rewards when your child accomplishes the task within 1 minute. You can use high-powered reinforcers when your child completes the direction in time to increase the impact of acknowledging their accomplishments within a specific time. Phase out the reinforcement when the skill has been sufficiently acquired. If the reinforcer for the behavior is a tangible item such as a small snack or a token for a token board ensure that it is provided with a great deal of verbal praise. Ideally, you want your child's positive behaviors to be supported solely by social reinforcement. If the behavior was not displayed, end the trial and provide the appropriate level of prompting on the following trial (e.g., model for your child how to go into the bathroom, pull pants and underwear down, and sit on the toilet for 1 minute). For example, you can use a stuffed toy or doll to show your child how to sit on the toilet while trying to urinate.

Step 5: Collect data on how your child makes progress on this task. For example, track progress by counting how many times your child is able to sit on the toilet and attempt to urinate within 1 minute when prompted in a given time interval. Alternatively, you can track progress by counting how many times in a row your child can sit on the toilet and attempt to urinate within 1 minute when prompted. Or, alternatively, you can track progress by counting the number of successful attempts at sitting on the toilet and attempting to urinate within 1 minute when prompted during a session.

Step 6: Track how your child makes progress to meet the target of sitting on the toilet while trying to urinate within 1 minute by comparing with either a number threshold or a percentage threshold (necessary to meet the target). For example, you can record the number of successful attempts at sitting on the toilet while trying to urinate within 1 minute over a certain number of sessions, and compare that with the number threshold necessary to meet the target. Alternatively, you can record what percentage of times your child can sit on the toilet while trying to urinate within 1 minute, and compare that with the percentage threshold necessary to meet the target.

For the short-term goal of requesting to visit the bathroom, you can choose a target such as requesting to visit the bathroom during playtime, requesting to visit the bathroom before or after a meal, or requesting to visit the bathroom before bed.

Requesting to Visit the Bathroom

Step 1: Decide when you would like to practice with your child requesting to visit the bathroom. For example, you can choose the target of requesting to visit the bathroom before bed while working on the short-term goal of requesting to visit the bathroom.

Step 2: An initial/specific discriminative stimulus (SD) should be selected that will cue your child that the task must start. This SD can be a picture (i.e., a picture of a toilet) or a verbal SD such as, “Do you need to go to the bathroom before bed? Ok, let’s go,” or, “Let’s go to the bathroom before bed! Sounds good?”

Step 3: Collect baseline level data by providing the SD from Step 2 and allowing your child to respond to your prompt independently. The baseline level will vary according to your child and their specific abilities. As an example, you can note if your child is able to respond affirmatively (verbally or otherwise) when asked if they need to go to the bathroom before bed over the course of their bedtime routine.

Step 4: To begin the trial to monitor progress towards meeting the target (i.e., the target of requesting to visit the bathroom before bed), provide the SD from Step 2 and allow your child to attempt independently. When your child is successful, provide reinforcement. Be generous with rewards when your child responds in the affirmative. You can use high-powered reinforcers when your child completes the direction in time to increase the impact of acknowledging their accomplishments within a specific time. Phase out the reinforcement when the skill has been sufficiently acquired. If the reinforcer for the behavior is a tangible item such as a small snack or a token for a token board ensure that it is provided with a great deal of verbal praise. Ideally, you want your child's positive behaviors to be supported solely by social reinforcement. If the behavior was not displayed, end the trial and provide the appropriate level of prompting on the following trial. For example, you can say to your child, “It’s almost bedtime. Should we go to the bathroom before we go to bed? Yes, we should,” and then go visit the bathroom together.

Step 5: Collect data on how your child makes progress on this task. For example, track progress by counting how many times your child is able to meet the target of responding affirmatively (verbally or otherwise) when asked if they need to go to the bathroom before bed over the course of their bedtime routine during a week. Alternatively, you can track progress by counting how many nights in a row your child is able to meet the target of responding affirmatively (verbally or otherwise) when asked if they need to go to the bathroom before bed. Or, alternatively, you can track progress by counting the number of times your child is able to meet the target of responding affirmatively (verbally or otherwise) before both bedtime at night and naptime(s) during the day.

Step 6: Track how your child makes progress to meet the target of requesting to visit the bathroom before bed by comparing with either a number threshold or a percentage threshold (necessary to meet the target). For example, you can record the number of your child’s successful attempts at responding affirmatively (verbally or otherwise) when asked if they need to go to the bathroom before bed, and compare that with the number threshold necessary to meet the target. Alternatively, you can record what percentage of times your child can respond affirmatively (verbally or otherwise) when asked if they need to go to the bathroom before bed, and compare that with the percentage threshold necessary to meet the target.

For the short-term goal of pulling off and pulling on pants, you can choose a target such as pulling off pants while sitting, pulling off pants while standing, or pulling off pants with a zipper and button.

Pulling Off Pants

Step 1: Decide how you want your child to practice pulling off a pair of pants in preparation for using the toilet. For example, you can choose the target of taking off pants while standing while working on the short-term goal of pulling off pants in preparation for using the toilet. The task analysis for pulling off pants while standing could be as follows:

1. Stand in front of the toilet.
2. Grab the waistband of the pants.
3. Pull the waistband down to ankles to lower pants.
4. Lift one leg and pull it out of the hole (optional: some children may find it easier to keep the waistband at their ankles while using the toilet).
5. Lift your other leg and pull it out of the other hole (optional: some children may find it easier to keep the waistband at their ankles while using the toilet).
6. Sit on the toilet.

Step 2: An initial/specific discriminative stimulus (SD) should be selected that will cue your child that the task will start. The SD may be visual, such as an image or flashcard showing a pair of pants or a verbal SD (“Time to take off pants to go potty!” or “Let’s take off your pants so you can sit on the toilet.”).

Step 3: Collect baseline level data by providing the SD from Step 2 and allowing your child to attempt independently. The baseline level will vary according to your child and their specific abilities. Take data on which steps were accurately done independently. For example, you can count how many steps in a row (from the task analysis in Step 1) your child can complete independently. Alternatively, if your child is able to complete the entire task analysis independently, record how long it takes your child to complete the entire task analysis independently during  a set amount of time (e.g., 5 min, 10 min, 15 min, etc.).

Step 4: To begin a trial for monitoring progress towards meeting the target (i.e., the target of taking off pants while standing in preparation for using the toilet), provide the SD from Step 2 and allow your child to attempt independently. When your child is successful, provide reinforcement. If the reinforcer for the behavior is a tangible item, such as a small snack or a token for a token board, ensure that it is provided with a great deal of verbal praise. Ideally, you want your child's positive behaviors to be supported solely by social reinforcement. If the behavior was not displayed, end the trial and provide the appropriate level of prompting on the following trial. For example, employ a model prompt to show your child what to do at the beginning of the following trial (e.g., model for your child standing in front of the toilet, pulling pants down to ankles, and then sitting down on the toilet). As an example, you can use a stuffed toy or doll to show your child how to pull pants down and sit on the toilet.

Step 5: Collect data on how your child makes progress. For example, count how many steps in a row (from the task analysis in Step 1) your child can complete independently. Decide if you want to utilize forwards or backwards chaining to teach the steps that your child may struggle to complete independently. Alternatively, you can track progress by recording how long it takes your child to complete all of the steps from the task analysis in Step 1. Or, alternatively, you can track progress by counting the number of successful attempts at taking off pants while standing in preparation for using the toilet during a session.

Step 6: Track how your child makes progress to meet the target of taking off pants while standing by comparing with either a number threshold or a percentage threshold (necessary to meet the target). For example, you can record the number of successful attempts at taking off pants while standing in preparation for using the toilet over a certain number of sessions, and compare that with the number threshold necessary to meet the target. Alternatively, you can record what percentage of times your child can complete all the steps from the task analysis in Step 1, and compare that with the percentage threshold necessary to meet the target.

For the short-term goal of voiding in the toilet, you can choose a target such as voiding in the toilet while standing or voiding in the toilet while sitting. 

Voiding in the Toilet

Step 1: Decide how you would like your child to practice voiding in the toilet. For example, you can choose the target of voiding (urinating) in the toilet while standing while working on the short-term goal of voiding in the toilet. The task analysis for voiding (urinating) in the toilet while standing could be as follows:

1. Lift toilet lid.
2. Lift toilet seat.
3. Toss a cheerio or other flushable floating cereal piece into the toilet bowl.
4. Optional: place step stool in front of toilet.
5. Optional: stand on step stool.
6. Pull down pants.
7. Pull down underwear.
8. Aim for the cheerio and void (urinate) at the cheerio.
9. Dry yourself using toilet paper or a wet wipe.
10. Toss toilet paper or wet wipe into the toilet bowl.
11. Put down the toilet seat.
12. Put down the toilet lid.
13. Flush toilet.
14. Wash hands.

Step 2: An initial/specific discriminative stimulus (SD) should be selected that will cue your child that the task will start. This SD can be a visual SD, such as an image of a toilet, or a verbal SD (“Time to practice peeing!” or “Let’s practice peeing on the cheerio!”).

Step 3: Collect baseline level data by providing the SD from Step 2 and allowing your child to attempt independently. The baseline level will vary according to your child and their specific abilities. Take data on which steps were accurately done independently. For example, you can count how many steps in a row (from the task analysis in Step 1) your child can complete independently. Alternatively, if your child is able to complete the entire task analysis independently, record how long it takes your child to complete the entire task analysis independently during a set amount of time (e.g., 1 min, 2 min, 5 min, etc.).

Step 4: To begin the trial to monitor progress towards meeting the target (i.e., the target of voiding (urinating) in the toilet while standing), provide the SD from Step 2 and allow your child to attempt independently. When your child is successful, provide reinforcement. If the reinforcer for the behavior is a tangible item, such as a small snack or a token for a token board, ensure that it is provided with a great deal of verbal praise. Ideally, you want your child’s positive behavior to be supported solely by social reinforcement. If the behavior was not displayed, end the trial and provide the appropriate level of prompting on the following trial. For example, employ a model prompt to show your child what to do at the beginning of the following trial (e.g., model for your child how to lift the toilet lid and seat, toss the cheerio into the toilet, then urinate into the toilet, followed by lowering the toilet seat and lid, and finally, flushing the toilet).  As an example, you can use a stuffed toy or doll to show your child how to void into the toilet.

Step 5: Collect data on how your child makes progress. For example, count how many steps in a row (from the task analysis in Step 1) your child can complete independently. Decide if you want to utilize forwards or backwards chaining to teach the steps that your child may struggle to complete independently. Alternatively, you can track progress by recording how long it takes your child to complete all the steps from the task analysis in Step 1. Or, alternatively, you can track progress by counting the number of successful attempts at voiding (urinating) in the toilet while standing over a certain number of sessions. 

Step 6: Track how your child makes progress to meet the target of voiding (urinating) in the toilet while standing over a certain number of sessions by comparing with either a number threshold or a percentage threshold (necessary to meet the target). For example, you can record the number of successful attempts at voiding (urinating) in the toilet while standing over a certain number of sessions, and compare that with the number threshold necessary to meet the target. Alternatively, you can record what percentage of times your child can complete all the steps from the task analysis in Step 1, and compare that with the percentage threshold necessary to meet the target.

For the short-term goal of wiping self after using the toilet, you can choose a target such as wiping self while sitting, or wiping self while standing.

Wiping Self After Using the Toilet

Step 1: Decide how you would like your child to learn to wipe themselves after using the toilet. For example, you can choose the target of wiping self while sitting after using the toilet while working on the short-term goal of wiping self after using the toilet. The task analysis for wiping self while sitting after using the toilet could be as follows:

1. While seated on the toilet, pull three squares of toilet paper (or a flushable wet wipe) from the toilet paper roll (or from the flushable wet wipes container).
2. Hold the toilet paper/wipe flat in your dominant hand. Use your non-dominant hand to hold on to the toilet or wall or other structure for balance as needed.
3. Lower the toilet paper or wipes between your legs. 
4. Wipe yourself from front to back once.
5. Look at the spent paper/wipe and note if it appears clean or dirty.
6. Drop the spent paper/wipe in the toilet.
7. Repeat Steps 1-5 until the spent paper/wipe appears clean (no soiled portions), which means you have wiped yourself clean.
8. Flush the toilet.

Step 2: An initial/specific discriminative stimulus (SD) should be selected that will cue your child that the task will start. This SD can be a visual SD, such as a piece of toilet paper or an image of a roll of toilet paper, or a verbal SD (“Time to wipe!” or “Let’s finish by wiping!”).

Step 3: Collect baseline level data by providing the SD from Step 2 and allowing your child to attempt independently. The baseline level will vary according to your child and their specific abilities. Take data on which steps were accurately done independently. For example, you can count how many steps in a row (from the task analysis in Step 1) your child can complete independently. Alternatively, if your child is able to complete the entire task analysis independently, record how long it takes your child to complete the entire task analysis independently during a set amount of time (e.g., 1 min, 2 min, 5 min, etc.).

Step 4: To begin the trial to monitor progress towards meeting the target (i.e., the target of wiping self while sitting after using the toilet), provide the SD from Step 2 and allow your child to attempt independently. When your child is successful, provide reinforcement. If the reinforcer for the behavior is a tangible item, such as a small snack or a token for a token board, ensure that it is provided with a great deal of verbal praise. Ideally, you want your child’s positive behavior to be supported solely by social reinforcement. If the behavior was not displayed, end the trial and provide the appropriate level of prompting on the following trial. For example, employ a model prompt to show your child what to do at the beginning of the following trial (e.g., model for your child how to sit on the toilet and grab toilet paper or wet wipes, then wipe yourself front to back, followed by dropping the toilet paper or wet wipes in the toilet and flushing).  As an example, you can use a stuffed toy or doll to show your child how to wipe self while sitting after using the toilet.

Step 5: Collect data on how your child makes progress. For example, count how many steps in a row (from the task analysis in Step 1) your child can complete independently. Decide if you want to utilize forwards or backwards chaining to teach the steps that your child may struggle to complete independently. Alternatively, you can track progress by recording how long it takes your child to complete all the steps from the task analysis in Step 1. Or, alternatively, you can track progress by counting the number of successful attempts at wiping self while sitting after using the toilet over a certain number of sessions.

Step 6: Track how your child makes progress to meet the target of wiping self while sitting after using the toilet by comparing with either a number threshold or a percentage threshold (necessary to meet the target). For example, you can record the number of successful attempts at wiping self while sitting after using the toilet over a certain number of sessions, and compare that with the number threshold necessary to meet the target. Alternatively, you can record what percentage of times your child can complete all the steps from the task analysis in Step 1, and compare that with the percentage threshold necessary to meet the target.

For the short-term goal of pulling down or pulling up underwear, you can choose a target such as pulling down underwear while sitting, pulling down underwear while standing, pulling up underwear while sitting, or pulling up underwear while standing.

Pulling up Underwear

Step 1: Decide how you want your child to practice pulling up or pulling down underwear. For example, you can choose the target of pulling up underwear while sitting while working on the short-term goal of pulling up or pulling down underwear. The task analysis for pulling up underwear while sitting might be:

1. After wiping, remain seated on the toilet.
2. Face the front of the underwear forward and the back of the underwear towards your belly.
3. Open the waist of the underwear.

7. If you had removed your legs from the underwear when pulling it down, put one of your legs into the underwear hole and pull your foot through.
8. Then, put your other leg into the other underwear hole and pull your foot through.
9. While lifting your bottom, pull the waist of the underwear up to your waist.

Step 2: An initial/specific discriminative stimulus (SD) should be selected that will cue your child that the task will start. The SD may be visual, such as an image or flashcard showing a pair of underwear or a verbal SD (“Time to put your underwear on!” or “Let’s pull up your underwear!”).

Step 3: Collect baseline level data by providing the SD from Step 2 and allowing your child to attempt independently. The baseline level will vary according to your child and their specific abilities. Take data on which steps were accurately done independently. For example, you can count how many steps in a row (from the task analysis in Step 1) your child can complete independently. Alternatively, if your child is able to complete the entire task analysis independently, record how long it takes your child to complete the entire task analysis independently during a set amount of time (e.g., 1 min, 2 min, 5 min, etc.). 

Step 4: To begin a trial for monitoring progress towards meeting the target (i.e., the target of pulling up underwear while sitting), provide the SD from Step 2 and allow your child to attempt independently. When your child is successful, provide reinforcement. If the reinforcer for the behavior is a tangible item, such as a small snack or a token for a token board, ensure that it is provided with a great deal of verbal praise. Ideally, you want your child's positive behaviors to be supported solely by social reinforcement. If the behavior was not displayed, end the trial and provide the appropriate level of prompting on the following trial. For example, employ a model prompt to show your child what to do at the beginning of the following trial (e.g., model for your child how to sit on the toilet with the underwear down, then pull legs through each hole one at a time, then pull underwear up to the waist). As an example, you can use a stuffed toy or doll to show your child how to pull up their underwear. 

Step 5: Collect data on how your child makes progress. For example, count how many steps in a row (from the task analysis in Step 1) your child can complete independently. Decide if you want to utilize forwards or backwards chaining to teach the steps that your child may struggle to complete independently. Alternatively, you can track progress by recording how long it takes your child to complete all of the steps from the task analysis in Step 1. Or, alternatively, you can track progress by counting the number of successful attempts at pulling up underwear while sitting during a session.

Step 6: Track how your child makes progress to meet the target of pulling up underwear while sitting by comparing with either a number threshold or a percentage threshold (necessary to meet the target). For example, you can record the number of successful attempts at pulling up underwear while sitting over a certain number of sessions, and compare that with the number threshold necessary to meet the target. Alternatively, you can record what percentage of times your child can complete all the steps from the task analysis in Step 1, and compare that with the percentage threshold necessary to meet the target.

For the short-term goal of washing hands after using the toilet, you can choose a target such as washing hands with liquid soap, washing hands with a bar of soap, or washing hands with foam soap.

Washing Hands After Using the Toilet

Step 1: Decide how you would like your child to learn to wash their hands after using the toilet. For example, you may choose the target of washing hands using liquid soap while working on the short-term goal of washing hands after using the toilet.The task analysis for washing hands using liquid soap might be:

1. Turn on the water and adjust to a pleasant temperature (that will likely not cause sensory issues).
2. Next, pump liquid soap into one hand by pressing the soap pump with the other hand.
3. Lather the soap, while singing a 30-second song, such as “Happy Birthday.” Make sure you get plenty of bubbles.
4. Rinse the soap.
5. Turn off the water.
6. Dry your hands.

Step 2: An initial/specific discriminative stimulus (SD) should be selected that will cue your child that the task will start. This SD can be a visual SD, such as an image of a sink with running water, or a verbal SD (“Time to wash hands!” or “Let’s wash our hands!”).

Step 3: Collect baseline level data by providing the SD from Step 2 and allowing your child to attempt independently. The baseline level will vary according to your child and their specific abilities. Take data on which steps were accurately done independently. For example, you can count how many steps in a row (from the task analysis in Step 1) your child can complete independently. Alternatively, if your child is able to complete the entire task analysis independently, record how long it takes your child to complete the entire task analysis independently during a set amount of time (e.g., 1 min, 2 min, 5 min, etc.).

Step 4: To begin the trial to monitor progress towards meeting the target (i.e., the target of washing hands using liquid soap), provide the SD from Step 2 and allow your child to attempt independently. When your child is successful, provide reinforcement. If the reinforcer for the behavior is a tangible item, such as a small snack or a token for a token board, ensure that it is provided with a great deal of verbal praise. Ideally, you want your child’s positive behavior to be supported solely by social reinforcement. If the behavior was not displayed, end the trial and provide the appropriate level of prompting on the following trial. For example, employ a model prompt to show your child what to do at the beginning of the following trial (e.g., model for your child how to turn on the water and test the temperature, then pump liquid soap in your hand, add water and lather, followed by rinsing your hands, turning off the water, and finally drying your hands).

Step 5: Collect data on how your child makes progress. For example, count how many steps in a row (from the task analysis in Step 1) your child can complete independently. Decide if you want to utilize forwards or backwards chaining to teach the steps that your child may struggle to complete independently. Alternatively, you can track progress by recording how long it takes your child to complete all the steps from the task analysis in Step 1. Or, alternatively, you can track progress by counting the number of successful attempts at washing hands using liquid soap over a certain number of sessions.

Step 6: Track how your child makes progress to meet the target of washing hands using liquid soap by comparing with either a number threshold or a percentage threshold (necessary to meet the target). For example, you can record the number of successful attempts at washing hands using liquid soap over a certain number of sessions, and compare that with the number threshold necessary to meet the target. Alternatively, you can record what percentage of times your child can complete all the steps from the task analysis in Step 1, and compare that with the percentage threshold necessary to meet the target.

For the short-term goal of remaining dry, you can choose a target such as remaining dry for the morning, remaining dry for the afternoon, or remaining dry for a period of time (e.g., 2 hours, 4 hours, 6 hours, etc.).

Remaining Dry

Step 1: Decide what time period you would like your child to work on remaining dry. For example, you can choose the target of remaining dry for the morning while working on the short-term goal of remaining dry. The task analysis for remaining dry for the morning could be as follows:

1. Wake up.
2. Visit the bathroom (optional: void in the toilet).
3. Have breakfast.
4. Play for 60 minutes.
5. Visit the bathroom (optional: void in the toilet).
6. Play for 60 minutes.
7. Have a snack.
8. Visit the bathroom (optional: void in the toilet).
9. Play for 60 minutes.
10. Have lunch.
11. Visit the bathroom (optional: void in the toilet).

Step 2: An initial/specific discriminative stimulus (SD) should be selected that will cue your child that the task will start. This SD can be a visual SD, such as an image of children having a meal (lunch), or a verbal SD (“Time to stay dry until after lunch!” or “Let’s stay dry until after lunch!”).

Step 3: Collect baseline level data by providing the SD from Step 2 and allowing your child to attempt independently. The baseline level will vary according to your child and their specific abilities. Take data on which steps were accurately done independently. For example, you can count how many steps in a row (from the task analysis in Step 1) your child can complete independently. Alternatively, if your child is able to complete the entire task analysis independently, record how long it takes your child to complete the entire task analysis independently during a set amount of time (e.g., 2 hours, 3 hours, 4 hours, etc.).

Step 4: To begin the trial to monitor progress towards meeting the target (i.e., the target of remaining dry for the morning), provide the SD from Step 2 and allow your child to attempt independently. When your child is successful, provide reinforcement. If the reinforcer for the behavior is a tangible item, such as a small snack or a token for a token board, ensure that it is provided with a great deal of verbal praise. Ideally, you want your child’s positive behavior to be supported solely by social reinforcement. If the behavior was not displayed, end the trial and provide the appropriate level of prompting on the following trial. For example, employ a model prompt to show your child what to do at the beginning of the following trial (e.g., model for your child how to eat breakfast, then periodically check to see if you need to go to the bathroom throughout the morning, followed by eating lunch, and finally, going to the bathroom).

Step 5: Collect data on how your child makes progress. For example, count how many steps in a row (from the task analysis in Step 1) your child can complete independently. Decide if you want to utilize forwards or backwards chaining to teach the steps that your child may struggle to complete independently. Alternatively, you can track progress by recording how long it takes your child to complete all the steps from the task analysis in Step 1. Or, alternatively, you can track progress by counting the number of successful attempts at remaining dry for the morning over a certain number of sessions. 

Step 6: Track how your child makes progress to meet the target of remaining dry for the morning by comparing with either a number threshold or a percentage threshold (necessary to meet the target). For example, you can record the number of successful attempts at remaining dry for the morning over a certain number of sessions, and compare that with the number threshold necessary to meet the target. Alternatively, you can record what percentage of times your child can complete all the steps from the task analysis in Step 1, and compare that with the percentage threshold necessary to meet the target.

Once your child has mastered all of the above short-term goals, you can begin practicing putting them all together (chaining) to work on mastering the long-term goal of toilet training, in which your child is able to complete the process of using the toilet independently. You can choose targets such as using the toilet independently upon waking up, using the toilet independently before bed, or using the toilet independently during playtime.

Using the Toilet Independently

Step 1: Decide when you would like your child to practice using the toilet independently. For example, you can choose the target of  using the toilet independently upon waking up while working on the short-term goal of using the toilet independently. The task analysis for using the toilet independently upon waking up  could be as follows:

1. Upon waking up, self-assess whether you need to go to the bathroom or not. 
2. Request to visit the bathroom and/or use the toilet. Alternatively, if prompted to visit the toilet upon waking up, respond affirmatively (verbally or otherwise).
3. Physically go into the bathroom to the toilet.
4. Sit on the toilet.
5. Pull off pants. 
6. Pull off underwear.
7. Urinate and/or void bowels into the toilet.
8. Wipe self after using the toilet.
9. Flush toilet.
10. Pull up underwear.
11. Pull up pants.
12. Stand up from the toilet and go to the bathroom sink.
13. Wash and dry hands.
14. Remain dry until needing to visit the bathroom again

Step 2: An initial/specific discriminative stimulus (SD) should be selected that will cue your child that the task will start. This SD can be a visual SD, such as an image of a child or adult sitting on the toilet, or a verbal SD (“Time to go to the bathroom!” or “Let’s go use the toilet!”).

Step 3: Collect baseline level data by providing the SD from Step 2 and allowing your child to attempt independently. The baseline level will vary according to your child and their specific abilities. Take data on which steps were accurately done independently. For example, you can count how many steps in a row (from the task analysis in Step 1) your child can complete independently. Alternatively, if your child is able to complete the entire task analysis independently, record how long it takes your child to complete the entire task analysis independently during a set amount of time (e.g., 5 min, 10 min, 15 min, etc.).

Step 4: To begin the trial to monitor progress towards meeting the target (i.e., the target of using the toilet independently upon waking up), provide the SD from Step 2 and allow your child to attempt independently. When your child is successful, provide reinforcement. If the reinforcer for the behavior is a tangible item, such as a small snack or a token for a token board, ensure that it is provided with a great deal of verbal praise. Ideally, you want your child’s positive behavior to be supported solely by social reinforcement. If the behavior was not displayed, end the trial and provide the appropriate level of prompting on the following trial. For example, employ a model prompt to show your child what to do at the beginning of the following trial (e.g., model for your child how to go into the bathroom, then use the toilet, wipe, and flush, followed by washing your hands). As an example, you can use a stuffed toy or doll to show your child how to use the toilet independently.

Step 5: Collect data on how your child makes progress. For example, count how many steps in a row (from the task analysis in Step 1) your child can complete independently. Decide if you want to utilize forwards or backwards chaining to teach the steps that your child may struggle to complete independently. Alternatively, you can track progress by recording how long it takes your child to complete all the steps from the task analysis in Step 1. Or, alternatively, you can track progress by counting the number of successful attempts at using the toilet independently upon waking over a certain number of sessions.

Step 6: Track how your child makes progress to meet the target of using the toilet independently upon waking by comparing with either a number threshold or a percentage threshold (necessary to meet the target). For example, you can record the number of successful attempts at using the toilet independently upon waking over a certain number of sessions, and compare that with the number threshold necessary to meet the target. Alternatively, you can record what percentage of times your child can complete all the steps from the task analysis in Step 1, and compare that with the percentage threshold necessary to meet the target.