Toilet Training Research

The Toileting Teacher uses only evidence-based strategies and emphasizes the most practical applications of applied behavior analysis to help toilet training for your child. We stay up-to-date on current research and recent publications so you don’t have to!

Toilet training or “potty training” strategies have evolved as our understanding of early childhood education and development has progressed. You many not want to potty train your child the same way your parents trained you. The following articles are some recent publications we found to be evidence-based and have incorporated into our practice. Please reach if you would like to discuss further!

1. We evaluated the combined and sequential effects of 3 toilet-training procedures recommended for use with young children: (a) underwear, (b) a dense sit schedule, and (c) differential reinforcement. A total of 20 children participated. Classroom teachers implemented a toilet-training package consisting of all 3 procedures with 6 children. Of the 6 children, 2 showed clear and immediate improvements in toileting performance, and 3 showed delayed improvements. Teachers implemented components of the training package sequentially with 12 children. At least 2 of the 4 children who experienced the underwear component after baseline improved. Toileting performance did not improve for any of the 8 children who were initially exposed to either the dense sit schedule or differential reinforcement. When initial training components were ineffective, teachers implemented additional components sequentially until toileting performance improved or all components were implemented. Toileting performance often improved when underwear or differential reinforcement was later added. [ABSTRACT FROM AUTHOR]

   Reference: Greer, B.D., Neidert, P.L., Dozier, C.L. A component analysis of toilet-training procedures recommended for young children. Journal of Applied Behavior Analysis. 2016;49(1):69-84. doi:10.1002/jaba.275

2. Toilet training is a significant developmental milestone in early childhood. Most U.S. children achieve the physiologic, cognitive, and emotional development necessary for toilet training by 18 to 30 months of age. Markers of readiness for toilet training include being able to walk, put on and remove clothing, and follow parental instruction; expressive language; awareness of a full bladder or rectum; and demonstrated dissatisfaction with a soiled diaper.

   Other readiness cues include imitating toileting behavior, expressing desire to toilet, and demonstrating bladder or bowel control (staying dry through a nap or through the night). Physicians should provide anticipatory guidance to parents beginning at about 18 to 24 months of age, noting the signs of toilet training readiness, and setting realistic expectations for parents. Parents should be counseled that no training method is superior to another. Parents should choose a method that is best suited to them and their child, and the method should use positive reinforcement. Complications of toilet training include stool toileting refusal, stool withholding, encopresis, hiding to defecate, and enuresis. These problems typically resolve with time, although some may require further investigation and treatment. Medical co-morbidities such as Down syndrome, autism spectrum disorder, and cerebral palsy reduce the likelihood of successfully attaining full toilet training and often require early consultation with occupational therapists, developmental pediatricians, or other sub-specialists to aid in toilet training.

   Reference: Baird, D.C. Toilet training: Common questions and answers. American Family Physician. 2019; 100(8).

3. The current study describes the use of a procedure called the "potty party", an all-day toilet training method using basic learning principles of “errorless” discrimination with 3 children with incontinence diagnosed with autism. At the start of treatment days, each participant was greeted and prompted to request the bathroom. After the child requested the bathroom, they were taken to the restroom, pants and underpants were removed, the child was seated on the toilet. While on-seat, participants were given liquids, less-preferred reinforcers and engaged in typical daily activities such as discrete trial training. When the child voided in the toilet, specific verbal praise and highly preferred edible reinforcers were delivered. The child was also given time off the toilet with their most preferred toys or items/activities. Time off-toilet subsequently increased with each in-toilet urination until the participants were spending the same amount of time off-toilet, out-of-bathroom, and in the classroom as their peers. Results for all three participants using 3 non-concurrent A-B phase designs indicated that the potty party procedure was effective in decreasing accidents to zero levels for all three participants and increased in-toilet urination for two. Future directions for research in toileting are discussed.

   Reference: Flora, S., Rach, J., & Brown, K. (2020). " Errorless" Toilet Training:" The Potty Party". International Electronic Journal of Elementary Education, 12(5), 453-457.

4. Toileting skills are a milestone typically achieved by the age of four. For many caregivers, particularly those who have children diagnosed with autism spectrum disorder or other developmental disabilities, teaching toileting is a challenge resulting in delayed implementation. Delaying toileting increases the risk of challenges to acquiring this skill. Caregivers are fundamental and research shows that their involvement supports the maintenance and sustainability of this skill. Four caregivers were taught a 24-step toilet training program to teach toileting. Behaviors measured included urination success, urine accident frequency, and child requests for the bathroom. All caregivers learned the 24-step procedure and the toilet training package was effective in teaching three of the four children daytime urine continence.

   Reference: Paquet Croteau, N., Moore, C., Griffith, A., & Franco, E. (2022). The Effects of a Caregiver Implemented Toilet Training Package. Journal of Autism and Developmental Disorders, 1-14.