Pat Mirenda, PhD, BCBA-D – University of British Columbia

Katie Rinald, PhD, BCBA – Blackbird Toileting Services

Filmed February 2021 – edited into 29 parts; total 432 minutes

Tackling toilet training successfully is crucial for a person to be fully included in the community. In this edited version of a two-day workshop, Professor Pat Mirenda and Katie Rinald return for an updated version of their 2014 presentation which has been ACT’s most popular online presentation.

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Presentation Handouts

• Presentation Handouts – Day 1
• Presentation Handouts – Day 2
• Long Way Baseline Data Sheet
• Long Way Intervention Data Sheet
• Rapid Toilet Training Data Sheet
• Toilet Training References 2021
• Use Guided Access with iPhone, iPad, and iPod touch
• Use of urine alarms in toilet training children with intellectual and developmental disabilities: A review

Part 1: Introduction

Topics Covered:

• Myths about toilet training
• Overview of toilet training methods: Rapid Toilet Training and The Long Way

Part 2: Getting Ready

Topics Covered:

• Preparing yourself
• Clothes and getting rid of diapers or pull-ups
• Seating

Additional links and resources

• mylilmiracle.com

Part 3: Importance of Reinforcers

Topics Covered:

• Identifying reinforcers
• Examples of outside-of-the-box reinforcers

Part 4: Bowel Training

Topics Covered:

• Considering medical issues
• Diet
• Other considerations: clothing, seating and reinforcement

Part 5: Introduction to Rapid Toilet Training (RTT)

Topics Covered:

• Background of RTT
• RTT disclaimer
• Is this trainee a good candidate for RTT?

Part 6: Getting ready for RTT

Topics Covered:

• Items needed for RTT
• Setting up
• What does RTT teach?
• Four key components
  • Increased fluids
  • Scheduled toilet sittings
  • reinforcement for correct toileting
  • Redirection for accidents

Part 7: Increased Fluids

Topics Covered:

• Do’s and Dont’s for increased fluids
• Examples of fluids

Part 8: Scheduled Toilet Sittings

Topics Covered:

• On and off toilet phases
• Using reinforcement
• Do’s and Dont’s for scheduled toilet sittings

Part 9: Scheduled Toilet Sitting Example

Topics Covered:

• How to record data
• What to do if there are accidents

Part 10: Reinforcement for Correct Toileting

Topics Covered:

• Purpose of reinforcement
• How to know if the reinforcement is working
• Examples of reinforcement
• Do’s and Dont’s for reinforcement

Part 11: Redirection for Accidents

Topics Covered:

• What to do if an accident occurs
• Do’s and Dont’s for redirection

Part 12: RTT Wrap-up

Topics Covered:

• Planning for intitation
• What’s next?

Part 13: RTT Dilemma

Topics Covered:

• Covering common questions and problems with RTT

The Long Way

Part 14: Urination Trip Training Part 1

Topics Covered:

• Urination “Trip Training” introduction
• Calculating how often to take the person to the toilet

Part 15: Urination Trip Training Part 2

Topics Covered:

• Communicating it’s time to pee
• Providing reinforcers
• What to do if an accident happens
• Filling out the data sheet

Part 16: Urination Self-Initiation

Topics Covered:

• Self-initiation and communication
• Identifying signals
• Gradually increasing trip intervals to prompt self-initation
• Fading reinforcers

Part 17: Bowel Movement Trip Training

Topics Covered:

• Figuring out when to take the person to the toilet
• Recording bowel movement times

Part 18: Bowel Movement Self-Initiation

Topics Covered:

• Self-initiation and communication
• Identifying signals
• Gradually increasing trip intervals to prompt self-initation
• Fading reinforcers

Part 19: Getting ready for Night Time Training

Topics Covered:

• Bed Wetting
• Consider medical issues
• Why you may want to wait to do nighttime training

Additional links and resources

• Items needed: chummiebedwettingalarm.com

Part 20: Night Time Urination Training

Topics Covered:

• What to do if the trainee has already peed by the time you’ve come to help
• What to do if the trainee hasn’t peed

Part 21: Night Time Bowel Training

Topics Covered:

• Could it be a problem behaviour issue?
• Talking to a doctor

Part 22: Case Study 1: The Dribbler

Part 23: Case Study 2: The Reluctant Pooper

Part 24: Case Study 3: The Quiet Pee-er

Part 25: Home-School Disconnect

Topics Covered:

• Different rules for home and school
• Instituting similar training programs at home and school
• Break time dilemma

Part 26: iPad Dilemma

Topics Covered:

• Using the iPad as a reinforcer and possible scenarios

Part 27: Tiny Poop/Constipation Dilemma

Topics Covered:

• Dealing with constipation
• D3 Cycle: discomfort-dread-delay
• A multidisciplinary plan to break the cycle

Q & A Part 1: Rapid Toilet Training

00:00 – Any tips for blind and deaf kids?

01:06 – What if there is no success?

01:29 – What counts as a rewardable pee in the toilet?

05:43 – Are there good names we should use for the reinforcers?

6:05 – Do we teach hand washing and flushing during Rapid Toilet Training?

6:33 – What if the child shows unwilling or aggressive behaviour?

6:59 – What if the trainee has an accident during the two-minute break?

7:16 – Is the trainee accessing the reinforcement for the entire break time?

10:33 – What happens if they tantrum when they have to stay in the bathroom?

10:47 – What are your suggestions for kids who hold pee too long? Bladder infections?

12:42 – Can you use RTT for a shorter number of hours?

15:17 – Is RTT done for the time the child wakes to the time the child goes to bed?

15:49 – What if the trainee stops peeing due to excitement?

16:19 – Would you offer different reinforcements and let them choose out of choices?

17:50 – What happens if the child requests for an item that’s not available?

19:06 – Does rapid training work for trainers who are already pee trained?

19:33 – Underwear inside pull-ups?

21:29 – This child let’s me know after they potty but not the she needs to ago, how do we address this?

22:07 – What do you think about ice cream for increasing fluid?

22:32 – I have a child who can go to the potty daily for a week at my parents, but won’t use it at home.

24:12 – When we provide activities during toilet sitting times, will that divert them from peeing or pooing?

24:54 – If you have a child who can go away for a week with no accidents but then comes home and has non-stop accidents, is this behavioural or is this child purposefully doing this?

25:51 – How do I get the child to make the toilet sign?

28:27 – Have hemorrhoids been an issue?

29:00 – Why have you removed the chair (prompting for self-initiations) from your RTT procedures?

31:57 – Should they not be in clothes during breaks?

32:31 – If it starts as an accident but they finish on the toilet, is that considered a success?

32:57 – Same amount of liquids for all of the phases?

33:29 – Can you comment on how this can work with kids with physical disabilities?

33:49 – Does the kid wear underwear during the five-minute break?

33:55 – How long does the trainee get with their reinforcement?

35:41 – How many hours in a day do we do this?

36:02 – Is the reinforcement interval the same as the break off the toilet?

36:28 – How do you treat bowel movement accidents during pee training?

37:00 – Should the child be naked? How can you see the accident on time otherwise?

37:55 – If I start RTT and it’s not working, how do I transition to The Long Way?

39:46 – Can you please clarify if there is a scheduled break after an accident off the toilet versus an accident that finishes on the toilet?

Q & A Part 2: The Long Way

00:00 – Is it possible kids might get distracted from pee and poo from the activities they are doing on the toilet?

1:03 – When you’re looking for the sweet spot, why don’t you round down?

2:05 – After mealtimes, my child may need to pee sooner than the average length of time, what should we do?

3:09 – How does the schedule depend from liquid consumption events?

4:27 – What about trainees who are resistant of the toilet from past training?

8:13 – Can we bring fun activities into the bathroom to help trainees stay on the toilet for long method trip training?

8:46 – How do you respond if they only partially empty?

9:31 – Can you use a visual schedule to remind them?

9:44 – What if the child is wet when you take them to sit but they also pee in the toilet?

10:13 – If you’re on a one hour and forty-five minute schedule and they initiate pee at one hour, do you wait another hour and forty-five minute to take them again or do you stay on your original schedule?

11:17 – When cleaning up after an accident, what can you say so they understand?

11:49 – If the trainee, who has no speech and AAC, already has initiation to pee into the toilet but has accidents occasionally, should the communication piece be introduced in the procedure?

13:15 – what if the learner says no and refuses when asked to go to the bathroom?

16:04 – Do you always need a tangible reinforcement in addition to praise?

16:43 – Are there alternatives for the bed wetting alarm?

18:38 – Have you ever used the wearable alarm during rapid toilet training and what were the outcomes?

21:05 – Which of the two methods are most effective?

22:04 – Would it be considered a punishment for not having a reinforcement in the morning if they wet the bed at night?

23:15 – Does the trainee get reinforcement if they trigger the alarm but finish in the toilet?

24:18 – I know my son has to go at five in the morning so I wake him up and prompt him to go, do we still need a wet bed alarm?

25:38 – What if they continue dribbling even during rapid toilet training?

27:25 – During the data collection phase, do you bring the trainee to the bathroom?

28:21 – If we’ve already started trip training, can we take baseline data from where the child is presently?

28:50 – Any suggestions for a child who hides in a closet to poop in his underwear?

29:45 – How can a non-verbal and non-pointing trainee do the self-initiation or tell me how they want to pee or poo.

30:55 – Trainee only has accidents on days when they are on their period?

32:57 – When fading the diaper for a reluctant pooper, could you empty the diaper into the toilet to show them where it should go?

33:22 – What about trainees who are not currently squatting to poop?

33:44 – Suggestions for a child who waits until nap time to poo in the diaper?

36:25 – How much water would you recommend for a 6 – 12 year old?

37:28 – How long should training sessions be during the Long Way?

38:19 – With respect to leaving the trainee in their clothing until the next interval, can you speak in detail as to how to to address caregivers who express concerns about dignity?

41:32 – Accidents at school?

45:17 – Once the bed pad gets wet, can it be used again in the same night?

45:31 – What about trainee’s who touch themselves a lot?

Brenda Fossett, PhD, BCBA-D, Capilano University

Filmed November 2020 – edited into 14 parts; total 213 minutes

Parents often assume that the difficulties they face in helping their children develop healthy daily routines are a part of their child’s autism and must be endured. This presentation provides parents and caregivers an overview of Positive Behavior Support (PBS) with the goal of supporting them to be proactive in helping neurodiverse children to be safely included in home, school and community activities. Core features of PBS include the application of behavioral science (ABA), the use of practical strategies to promote desired behavior, and a focus on improving the quality of life for the individual and their family. 

A goal of this presentation is to increase parental awareness of good PBS service, so they can find a behavior consultant to support them in using positive strategies to address essential functional skills, including toileting, sleep and mealtimes. Importantly, parents will learn about positive strategies they can begin using immediately with young children to lessen the child’s reliance on destructive or self-injurious behaviors to communicate their distress. Parents of older children will better understand the challenges their children are experiencing  and how to identify skilled support to provide the young person with positive ways of having their needs met while being fully included in their community. 

Learning Outcomes

At the end of this workshop, participants will be able to:

• Define Positive Behavior Support
• Identify common misconceptions regarding PBS
• Identify common purposes served by problem behavior
• Identify components of a quality PBS-based intervention
• Describe common preventative strategies

Presentation Handout (40 Pages)

Presenter Bio

Brenda Fossett is an inspired teacher who is widely admired for her ability to convey complex concepts to those who work with children and adults with diverse needs, whether they are educational professionals or parents.  Dr. Fossett has been on faculty in the Applied Behavior Analysis – Autism Department at Capilano University since 2013. She is a certified teacher of the deaf and a Board Certified Behavior Analyst. Dr. Fossett has extensive clinical experience providing behavioral and educational consultative services to children with ASD, deafness, and other developmental conditions in home, school, and community settings. Her scholarly and clinical interests include: applied behavior analysis, the implementation of positive behavior support in home and school settings, and educational interventions for deaf children with developmental disabilities. 

Part 1: Positive Behavior Support Introduction

Topics Covered: 

• Traditional vs. current views on behaviour
• Application of behavioral science
• PBS process

Part 2: Functional Behavior Assessment

Topics Covered: 

• Identifying problem behaviors
• Four functions of behaviour

Part 3: Indirect Assessment

Topics Covered: 

• Gaining information from relevant sources
• Identifying physical and environmental factors that influence behaviors
• Identifying functions of behaviors

Part 4: Direct Assessment and Functional Analysis

Topics Covered: 

• How to gather evidence to support hypotheses regarding problem behavior
• What information direct observation should provide
• When functional analysis is needed

Part 5: Designing PBS Plans and Setting Events

Topics Covered: 

• Identifying setting events and possible strategies
• Preventing setting events from occurring
• Reducing impact of setting events

Part 6: Antecedent Strategies

Topics Covered: 

• Increase cues for appropriate behaviors
• Decrease cues for problem behaviors

Part 7: Teaching Strategies

Topics Covered: 

• How to pick teaching strategies based on context, challenges and goals.
• Functional Communication Training (FCT)

Part 8: Consequence Strategies

Topics Covered: 

• How to increase desired behaviors
• How to increase alternative replacement behaviors

Part 9: PBS Example: Transition to Bath Time

References video shown in Part 4.

Topics Covered: 

• Breaking down an example of PBS

Part 10: Accessing PBS Services

Topics Covered: 

• What to look for in a PBS service
• Behavioral parent training
• Data collection systems

Part 11: Introduction to Visual Support Strategies to Prevent Problem Behavior

Topics Covered: 

• Challenges in processing speech or sign language
• Predictability and ease transitions
• Understanding expectations

Part 12: Visual Support Strategies

Topics Covered: 

• Environmental supports
• Visual schedules
• Object cue schedules
• Within activity schedules

Part 13: Visual Support Strategies Continued

Topics Covered: 

• Rule supports
• ‘Universal No’ symbol
• Choice Boards
• Waiting Supports

Part 14: Putting it All Together

Topics Covered: 

• Collaborative Partnerships
• Parents’ roles