Toilet Training: Strategies Involving Modeling and Modifications of the Physical Environmental

Abstract

Toilet training is a social learning process requiring interactions between young children and their parents and caregivers over extended periods of time, typically in the first 2 to 4 years of life. It is a complex process involving both developmental maturation and learning, and not all children respond sufficiently to the conventional techniques encountered in their specific family and cultural context to achieve excretory continence and culturally appropriate toileting practices (Kaerts et al., Scandinavian Journal of Urology and Neophrology 46:424–430, 2012). Thus, for some, additional strategies are needed in order for continence and toileting to be learned (Kaerts, et al., Scandinavian Journal of Urology and Neophrology 46:424–430, 2012). Such strategies may include motivating and prompting the behavior, manipulation of antecedent stimulus control, and/or facilitative environmental modifications, as well as providing salient consequences for correct performance. In this chapter, selected strategies will be described, guidelines for implementing them provided, and the research base supporting their use evaluated. First, to put these intervention options in context, the chapter begins with a brief biobehavioral analysis of the development of bladder and bowel continence and of the key skills that must be acquired for toileting to be done reliably and independently.