Toilet Training For Everyone – Revised And Expanded

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.

  • Part 1-4: Dr. Mirenda gives an overview of toilet training myths and a wide range of issues to think about in preparation for any type of training.
  • Part 5-13: Katie Rinald provides detailed information about intensive, rapid toilet training (RTT) during the daytime hours, including straightforward strategies for both “pee” and “poop” training.
  • Part 14-18: Pat describes a step-by-step procedure for less intensive toilet training during the daytime. This method will be most appropriate for school-based training or for home-based training when caregivers are not able to devote the time required for RTT.
  • Part 19-21: Katie discusses strategies for nighttime training that can be used with people who are already continent during the daytime hours.
  • Part 22-24: provide case studies that describe solutions to specific training challenges. These include, for example, “my child is pee trained but refuses to poop on the toilet”, “my child won’t initiate but is fully trip trained”, and “my child will only use the toilet with one parent and no one else”.
  • Part 25: Pat discusses the disconnect between toilet training at school and home, and solutions for continuing training between these settings.
  • Part 26: Katie talks about different scenarios for using iPads during toilet training.
  • Part 27: Katie gives an overview of handling dilemmas involving constipation and tiny poops.
  • Q&A: The question & answer section addresses common questions from parents asked during the event.

Presenter Bio

Pat Mirenda is Professor Emerita in the Department of Educational and Counselling Psychology and Special Education at the University of British Columbia. She is a doctoral-level Board Certified Behaviour Analyst and has taught courses on autism spectrum disorder, instructional techniques for students with significant learning challenges, and positive behavior support.

Katie Rinald is an expert on toilet training for children with developmental disabilities and applies behaviour analytic methodology to solve complex toileting challenges. She is a Board Certified Behaviour Analyst and a PhD candidate in Inclusive Education.  Katie and her team have helped individuals from 2 to 20 achieve toileting success.  She is Director of BC-based Blackbird Toileting Services, and provides virtual consultation on toileting challenges to families internationally.

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Presentation Handouts

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

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

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?