Toilet Training for Students with Severe and Multiple Disabilities

Phyllis E. Brodsky, M.Ed.

Equipment and Materials

toilet
and
shower system

Rifton

Equipment and Materials

fully supported

Equipment and Materials

flush

Equipment and Materials

arm stability

Equipment and Materials

stand alone

Equipment and Materials

seating

Equipment and Materials

fun

Equipment and Materials

splash guards

Equipment and Materials

selfwipe.com

Equipment and Materials

wipes

Equipment and Materials

targets

Toilet Training for Students with Severe and Multiple Disabilities

Dignity
our language (word choice,
intonation, timing)
privacy (supplies)
privacy (location)
privacy (people in earshot)

Toilet Training for Students with Severe and Multiple Disabilities

Make the Commitment!

detrimental effect of
starting and stopping
need home parent
permission but can
proceed even without
follow through
assuring availability of
time and staff

Toilet Training for Students with Severe and Multiple Disabilities

Something is Better
Than Nothing!
touch cues
communication
hand under hand
participation in
related activities

Toilet Training for Students with Severe and Multiple Disabilities

Get Ready, Get Set, Go!

Skill Assessment
Make the commitment!
Be aware of variables.
Gather the information.
Collect the data.
Design the plan.
Implement the plan.
Review the plan.
Modify the plan as needed.

Toilet Training for Students with Severe and Multiple Disabilities

Get Ready: Skill Assessment

communication
fine motor skills
gross motor skills
cognitive skills
sensory skills
social skills

Toilet Training for Students with Severe and Multiple Disabilities

Quick Thinking!

How might a childs dignity be respected

during a diaper change?

Toilet Training for Students with Severe and Multiple Disabilities

Get Ready: Be Aware of Differences

family
terminology
cultural norms
individual
preferences
anatomy and
physiology

Toilet Training for Students with Severe and Multiple Disabilities

Get Ready: Family

family approval
lack of family
involvement isnt an
excuse (for toileting or
anything else)
parents right to have
input with or without
their follow through

Toilet Training for Students with Severe and Multiple Disabilities

Get Ready: Gather History

What has been tried?
How long was it attempted?
Who attempted it?
Why was it stopped?
What were the successes?
What was the method?

Toilet Training for Students with Severe and Multiple Disabilities

Get Ready: Identify Barriers

physiological issues
such as colostomies,
spasticity, atypical
anatomy
fear of bathroom or
sitting on the toilet
auditory sensitivity to
flushing or acoustics

Toilet Training for Students with Severe and Multiple Disabilities

Get Ready: Identify Barriers

negative reactions to
having diaper
removed
emotional attachment
to feces
ineffective use of toilet
paper

Toilet Training for Students with Severe and Multiple Disabilities

Get Ready: Identify Barriers

playing with toilet
paper
touching or stimulating
own body
touching or playing
with urine or feces
touching or playing
with toilet water

Toilet Training for Students with Severe and Multiple Disabilities

Get Ready: Medical History

hospitalizations
urinary tract infections
intestinal illnesses
medication or
allergies
diarrhea or
constipation

Toilet Training for Students with Severe and Multiple Disabilities

Get Ready: Diet

food allergies/sensitivity
fat content of foods
fiber content of foods
frequency and quantity to
access fluids
typical kinds of fluids
(diuretics?)
dairy

Toilet Training for Students with Severe and Multiple Disabilities

Quick Thinking!

What might you consider when

communicating with a family about
the role of diet in toilet training?

Toilet Training for Students with Severe and Multiple Disabilities

Get Set: Collect the Data

decide frequency of data collection
record all conditions (wet, dry, toilet
use)
record consistent times of the day
minimum of 2 typical weeks (10
typical school days) unless pattern is
clear
hold off if consistent data can not be
obtained

Toilet Training for Students with Severe and Multiple Disabilities

TOILET TRAINING DATA FORM

Legend: PNT=pants TLT=toilet D=dry W=wet BM=bowel movement U=urine
Dates:
TIME
7 AM
8 AM
9 AM
10
AM
11
AM
12 PM
1 PM
2 PM
3 PM
4 PM
5 PM
6 PM
7 PM
8 PM
9 PM

DAY 1
DAY 2
PNT
TLT PNT TLT

DAY 3
DAY 4
DAY 5
DAY 6
DAY 7
PNT TLT PNT
TLT PNT TLT PNT TLT PNT TLT

Toilet Training for Students with Severe and Multiple Disabilities

Get Set: Design the Plan

motor planning and positioning
special equipment
specific clothing
cleaning method
related skills and sequences
(hand washing, use of doors,
bathroom spray)

Toilet Training for Students with Severe and Multiple Disabilities

Get Set: Design the Plan

short and long term goals of instruction (IEP)
communication needs
sensory awareness/issues
need for routines or rituals

Toilet Training for Students with Severe and Multiple Disabilities

Get Set: Design the Plan

consider the age
consider the gender
consider partial participation
determine methodology
determine materials

Toilet Training for Students with Severe and Multiple Disabilities

Get Set: Design the Plan

Rewards
artificial vs. intrinsic
food
praise
clean pants
pride
peer acceptance

Toilet Training for Students with Severe and Multiple Disabilities

Get Set: Design the Plan

Methods
trip training
fluid management
bowel program
Azrin and Foxx

Toilet Training for Students with Severe and Multiple Disabilities

Get Set: Design the Plan

Materials
visual cues
visual sequence
augmentative
communication
books (topic or
non-topic
related)
apps

Toilet Training for Students with Severe and Multiple Disabilities

Get Set: Design the Plan

Instruction
instruction inside
the bathroom
instruction
outside the
bathroom
(dignity, please)

Toilet Training for Students with Severe and Multiple Disabilities

Quick Thinking!

Do these flash cards fit within the

concepts of best practices?
Why or why not?

Toilet Training for Students with Severe and Multiple Disabilities

Go!
Implement!
Review!
Modify!

Toilet Training for Students with Severe and Multiple Disabilities

Case Studies
1. What additional information would you
want to seek through an interview with the
family?
2. What additional information would you
want to seek through observation?
3. What additional data would you want?
4. State a single observable skill that your
student could learn.

Toilet Training for Students with Severe and Multiple Disabilities