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Investigation of Teacher-Mediated Toilet Training Using a Manualized Moisture Alarm Intervention


  • Early Childhood (3-5 years)
  • Middle Childhood (6-11 years)


Urinary incontinence is a significant threat to the quality of life for people with autism spectrum disorder (ASD) and other disabilities, jeopardizing their autonomy, community inclusion, comfort, hygiene and peer acceptance. Despite repeated and prolonged efforts of caregivers, some individuals are not trained to use the toilet by their school-age years or beyond. For these individuals, next-step training methods often require expert consultation and methods that are time-consuming, disruptive and difficult to implement in everyday settings (e.g., home, school). A training method that requires minimal expert consultation, can be implemented with a high degree of caregiver fidelity, and increases the rate of toileting skill acquisition over standard methods is greatly needed. In this three-center randomized clinical trial, we propose to prepare an innovative teacher-mediated manualized toilet training intervention that employs a wireless moisture pager for large-scale testing and conduct an RCT comparison of this intervention with a teacher-mediated behavioral intervention that represents the current standard of care. Participants will be recruited in 30 community classroom settings (60 children with ASD aged 3 - 10). Classrooms will be randomly assigned to one of the two treatment conditions. Each condition will entail an initial, comprehensive staff training conducted by the researchers and 3 follow-up sessions during a 3-month active toilet training period. Outcome measures will include measures of study feasibility (i.e., achievement of recruitment targets, successful randomization, retention, intervention fidelity) and comparison of interventions (i.e., rate of accidents and toilet use, and independence of skilled toileting behavior at end of three-month intervention phase, teacher satisfaction).

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