Below is a general skill sequence for introducing the first stages of toileting.
Among the myriad skills aimed at enhancing a learner's quality of life, toileting stands as one of the most impactful. This skill area focuses on preparing the learner for toilet training by initially concentrating on simple, single-step tasks. The aim is to ease the learner into the more complex aspects of toileting by first mastering foundational behaviors such as hand-holding, transitioning from one location to another, and sitting for extended periods. These preparatory steps offer the learner a gradual introduction to the toilet training process, making it less daunting and more achievable. Additionally, continuing to work on "mands" (requests) for locations can serve as a complementary skill set, aiding the learner in effectively communicating their needs during toilet training. Mastery in these preliminary skills sets the stage for successful toilet training, which is an essential life skill that significantly impacts the learner's independence and overall quality of life.
How this skill area relates to your assessments!
This skill area aligns with various assessments and their respective domains, with milestone and domain codes provided for reference. Additionally, DSM-5 diagnostic criteria for Autism are included to help clinicians identify how this skill area potentially supports medical necessity in relation to the diagnosis.
VB-MAPP (Verbal Behavior Milestones Assessment and Placement Program)
Mand, M 2-M, Emits 4 mands w/o prompts except item and/or “What do you want?”
Visual Perception/Match to Sample, VPMS 2-M, Grasps small objects with thumb, index finger, and middle finger (pincer grasp) 5 times.
Motor Imitation, MI 6-M, Imitates 10 actions that require selecting a specific object from an array (e.g., selects a drumstick from an array also containing a horn and a bell, and imitates an adult’s drumming).
Group, G 11-M, Uses the toilet and washes hands with only verbal prompts.
AFLS (Assessment of Functional Living Skills)
Self Management, SM19, Remains calm during hygiene and grooming routines.
Toileting, TL3, Expresses when wet
Toileting, TL4, Expresses when soiled
Toileting, TL6, Sits on toilet and keeps hands out of toilet water
Toileting, TL7, Urinates in toilet
Toileting, TL8, Defecates in toilet
Basic Skills, BS23, Maintains adequate hygiene at job.
DSM-V Diagnostic Criteria for Autism
A2, Deficits in nonverbal communicative behaviors used for social interaction, ranging, for example, from poorly integrated verbal and nonverbal communication; to abnormalities in eye contact and body language or deficits in understanding and use of gestures; to a total lack of facial expressions and nonverbal communication.
CDC’s Developmental Milestones
30 Months, Social/Emotional, Follows simple routines when told, like helping to pick up toys when you say, “It’s clean-up time.”
30 Months, Cognitive, Shows simple problem-solving skills, like standing on a small stool to reach something.
Treatment Plan Goal Ideas
This is a list of treatment plan goals. These are different from the goals you will find in the skill sequence below. Your treatment plan goals encompass any number of goals from the skill sequence. Sometime they will include multiple goals from the sequence (”Learner will label 5 toys”) and sometimes the treatment plan goal will be simply consist of a really important goal from the skill sequence (”Will label caregiver”). An analogy I like to use goes as follows: Each skill sequence goal (commonly known as a “target”) represent each stair in a flight of stairs. The treatment plan goal is the flight itself.
Treatment plan goal ideas for this particular skill area are as follows:
Learner will sit on the toilet when asked to do so.
Learner will sit on a toilet when taken on a schedule.
Component Skills
Your learner may need to be fluent in these component skills first before introducing this goal/skill area. Component skills for this skill sequence may include skill areas that are fundamental to other areas. Fluency in the skill areas listed below may increase the likelihood that your learner will succeed in this skill sequence and those afterward.
Below is a possible skill sequence for working on increasing your learner’s ability to engage in the first steps of toileting. Note that every learner is different and that you likely will need to tweak and vary some programming to their needs. Click the triangle icon to view the full description for each skill in the sequence/area.
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#1 Walks into restroom for SR+
How to Run
Gain the attention and motivation of the learner.
Present an outstretched hand or ask them to walk with you to the restroom. “Let’s go to the bathroom!”
Learner should grab the outstretched hand or walk with you.
Once the learner has walked into the restroom, immediately administer social praise and grant access to preferred item/activity.
Additional Notes
Always ensure that the learner’s dignity, privacy, and safety are respected when running programs such as this one. Further, ensure that caregivers are comfortable with the team embarking in teaching toileting in the first place.
Materials
Research/Resources
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#2 Mands for restroom for SR+
How to Run
Gain the attention and motivation of the learner.
Let them know that a preferred item or activity is available but they need to go to the bathroom first. “We can have the iPad, but we need to go to the bathroom to get it!”
Learner should mand to go to the bathroom (given they have the repertoire to do so).
Immediately take the learner to the bathroom.
Once they walk in, contrive another mand for the desired item/activity (if appropriate).
Grant access to the preferred item/activity.
Additional Notes
Always ensure that the learner’s dignity, privacy, and safety are respected when running programs such as this one. Further, ensure that caregivers are comfortable with the team embarking in teaching toileting in the first place.
Reserving a specific, high value reinforcer(s) exclusively for this program may increase the motivation for the learner to engage in the desired behavior.
Materials
Research/Resources
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#3 Sits on toilet (pants up, lid down) for SR+
How to Run
Gain the attention and motivation of the learner.
Present an outstretched hand or ask them to walk with you to the restroom and sit on the toilet. “Let’s go to the bathroom and sit on the toilet!”
Learner should walk to the bathroom and sit down on the toilet. Note that their pants can be up and they can sit on the lid (if appropriate).
Once the learner sits down, immediately administer social praise and grant access to preferred item/activity.
Additional Notes
Always ensure that the learner’s dignity, privacy, and safety are respected when running programs such as this one. Further, ensure that caregivers are comfortable with the team embarking in teaching toileting in the first place.
Materials
Research/Resources
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#4 Sits on toilet (pants up, on seat) for SR+
How to Run
Gain the attention and motivation of the learner.
Present an outstretched hand or ask them to walk with you to the restroom and sit on the toilet. “Let’s go to the bathroom and sit on the toilet!”
Learner should walk to the bathroom and sit down on the toilet. Note that their pants can be up but they should sit on the toilet seat (lid up).
Once the learner sits down, immediately administer social praise and grant access to preferred item/activity.
Additional Notes
Always ensure that the learner’s dignity, privacy, and safety are respected when running programs such as this one. Further, ensure that caregivers are comfortable with the team embarking in teaching toileting in the first place.
Materials
Research/Resources
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#5 Sits on toilet (pants down, on seat) for SR+
How to Run
Gain the attention and motivation of the learner.
Present an outstretched hand or ask them to walk with you to the restroom and sit on the toilet. “Let’s go to the bathroom and sit on the toilet!”
Learner should walk to the bathroom, pull down pants (may require assistance) and sit down on the toilet seat.
Once the learner sits down, immediately administer social praise and grant access to preferred item/activity.
Additional Notes
Always ensure that the learner’s dignity, privacy, and safety are respected when running programs such as this one. Further, ensure that caregivers are comfortable with the team embarking in teaching toileting in the first place.
Materials
Research/Resources
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#6 Sits on toilet for 30 seconds with SR+
How to Run
Gain the attention and motivation of the learner.
Present an outstretched hand or ask them to walk with you to the restroom and sit on the toilet. “Let’s go to the bathroom and sit on the toilet!”
Learner should walk to the bathroom, pull down pants (may require assistance) and sit down on the toilet seat.
Once the learner sits down, immediately grant access to preferred item/activity.
Learner should remain seated on the toilet for 30 seconds while engaged with preferred item/activity.
Once 30 seconds has elapsed, remove the preferred item/activity, have them stand up, and pull up their pants.
Additional Notes
Always ensure that the learner’s dignity, privacy, and safety are respected when running programs such as this one. Further, ensure that caregivers are comfortable with the team embarking in teaching toileting in the first place.
Materials
Research/Resources
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#7 Sits on toilet for 30 seconds to access SR+
How to Run
Gain the attention and motivation of the learner.
Present an outstretched hand or ask them to walk with you to the restroom and sit on the toilet. “Let’s go to the bathroom and sit on the toilet!”
Learner should walk to the bathroom, pull down pants (may require assistance) and sit down on the toilet seat.
Learner should remain seated on the toilet for 30 seconds without getting up or putting their hands in the water.
Once 30 seconds has elapsed, have the learner stand, pull up their pants (may require assistance). Therapist should grant access to the preferred item/activity as quickly as possible.
Additional Notes
Reserving a specific, high value reinforcer(s) exclusively for this program may increase the motivation for the learner to engage in the desired behavior.
It is important to grant as immediate access as possible to the preferred item/activity contingent on the desired response. For example, if the learner wants the iPad, you may hand them the iPad while you’re lifting them off the toilet and pulling their pants up.
Always ensure that the learner’s dignity, privacy, and safety are respected when running programs such as this one. Further, ensure that caregivers are comfortable with the team embarking in teaching toileting in the first place.
Materials
Research/Resources
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#8 Mands to sit on toilet for SR+
How to Run
Gain the attention and motivation of the learner.
Let them know that a preferred item or activity is available but they need to sit on the toilet first. “We can have the iPad, but we need to go to the bathroom to get it!”
Learner should mand to go to the bathroom (given they have the repertoire to do so). “I want to go to the potty!”
Take the learner to the toilet, pants should be pulled down, and the learner should sit down.
Start a timer or count for 30 seconds.
Once the 30 seconds has elapsed, learner should stand, pull up their pants (or therapist should help), and therapist should grant access to the preferred item or activity as quickly as they can in this process.
Additional Notes
Reserving a specific, high value reinforcer(s) exclusively for this program may increase the motivation for the learner to engage in the desired behavior.
It is important to grant as immediate access as possible to the preferred item/activity contingent on the desired response. For example, if the learner wants the iPad, you may hand them the iPad while you’re lifting them off the toilet and pulling their pants up.
Always ensure that the learner’s dignity, privacy, and safety are respected when running programs such as this one. Further, ensure that caregivers are comfortable with the team embarking in teaching toileting in the first place.
Materials
Research/Resources
Concurrent Skills
Working on these skills at the same time could help with goal mastery. Maybe your learner has mastered these skills already. Perhaps they are already listed as component skills above. That’s okay! Targeting other learning channels might help your learner.
These are the possible next steps for learners who have mastered, or are mastering, the skills listed above. Note that new skill areas may require fluency in other component skills not listed above. Also, you can introduce composite skill sequences prematurely to keep your learner progressing, as generativity may occur earlier than expected.
Advanced Toileting (Coming Soon!)
Follow the link below to better understand component-composite analysis.
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Research and Resources
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Disclaimer
Consistent with ethical obligations outlined by the Behavior Analysis Certification Board (BACB), users acknowledge that goal selection/direction is the responsibility of the BCBA. Users understand that goals should be tailored to the learner while ultimately involving the input of clients/stakeholders. Users understand their ethical obligations to the client/stakeholder concerning the selection, implementation, design, and minimization of risk regarding behavior change interventions as outlined in BACB Code. As such, this skill sequence serves as a general framework for generating ideas around this particular skill area and not as an assessment or curriculum.
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Intro to Reinforcer/Preference Expansion
Intro to Manding
Imitates Actions with Preferred Items
Performs Preferred Action with Preferred Item (LR)
Performs Action During Familiar Routines (LR)
Intro to Sitting 
Intro to Handholding
Manding for Locations
Intro to Dressing
Intro to Washing Hands
Intro to Wiping 
Intro to Faucets/Dials
Wiping After Bowel Movements
Transitioning With Others