Below is a general skill sequence for helping learners wipe after using the restroom.
One of the most difficult skills to teach are those related to toileting and hygeine. Wiping especially can be a challenge. The aspect of this behavior that is most challenging is that—when done independently—the learner must select the appropriate amount of toilet tissue and and wipe an area that is out of their line of vision. This skill area seeks to help the learner practice both of these skills in addition to helping them recognize when it is time to stop wiping. As the learner masters this skill area, in addition to consistent voiding and manding to do so, they quickly approach complete independence regarding toileting.
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)
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, TL10, Uses toilet paper.
Basic Skills, BS23, Maintains adequate hygiene at job.
DSM-V Diagnostic Criteria for Autism
A1, Deficits in social-emotional reciprocity, ranging, for example, from abnormal social approach and failure of normal back-and-forth conversation; to reduced sharing of interests, emotions, or affect; to failure to initiate or respond to social interactions.
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 select the appropriate amount of toilet paper across three toileting settings.
Learner will select the appropriate amount of toilet paper in a toileting setting, wipe a visible surface, and stop wiping once the surface is adequately wiped across three settings.
Learner will independently and adequately wipe themselves after a bowel movement without prompting across three different toileting settings.
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 wipe themselves when 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 Grabs 8 sheets of toilet paper
How to Run
Gain the attention and motivation of the learner.
Ask the learner to get some toilet paper. “Grab some toilet paper!”
Learner pull down toilet paper and tear off +/- 8 sheets.
If the learner can count with point-to-point correspondence, have them count 8 sheets and tear it off.
If they cannot count, have them pull the lowest hanging sheet to the floor (without it touching the ground), and tear it off.
Reinforce accordingly.
Additional Notes
Materials
Toilet Paper
Research/Resources
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#2 Grabs toilet paper, wipes visible surface
How to Run
Gain the attention and motivation of the learner.
Ask the learner to get some toilet paper. “Grab some toilet paper!”
Learner pull down toilet paper and tear off +/- 8 sheets.
If the learner can count with point-to-point correspondence, have them count 8 sheets and tear it off.
If they cannot count, have them pull the lowest hanging sheet to the floor (without it touching the ground), and tear it off.
Present a flat surface with a small spill (about a half inch in diameter) that the learner cannot see. The spilled liquid should have some color to it.
Learner should wipe the spill with the toilet paper.
Once the learner wipes the surface, they should check the toilet paper to see if there is colored liquid on it.
If there is colored liquid, the learner should grab more toilet paper and follow the process again.
Repeat the process until the toilet paper has no colored residue on it, thus indicating that the surface is clean.
Reinforce accordingly.
Additional Notes
The trick here is to have the learner look at the toilet paper after they have wiped the surface. The learner should begin to use the toilet paper as a sign of whether or not a surface is clean or dirty. The goal is for the toilet paper to be the stimulus for whether or not the learner keeps wiping.
Talk the learner through the process, especially in the beginning stages.
Materials
Toilet Paper
Colored residue. Brown washable paint or brown food coloring are viable options. You can also use a brown dry-erase marker in a pinch.
Research/Resources
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#3 Grabs toilet paper, wipes unseen surface
How to Run
Gain the attention and motivation of the learner.
Ask the learner to get some toilet paper. “Grab some toilet paper!”
Learner pull down toilet paper and tear off +/- 8 sheets.
If the learner can count with point-to-point correspondence, have them count 8 sheets and tear it off.
If they cannot count, have them pull the lowest hanging sheet to the floor (without it touching the ground), and tear it off.
Present a surface with a small spill (or similar) that the learner cannot see. The spilled substance should have some color to it.
Ex: Tape a laminated sheet to the bottom of a chair or table and color with dry erase marker.
Learner should wipe the spill with the toilet paper without looking.
Once the learner wipes the surface, they should check the toilet paper to see if there is colored substance on it.
If there is colored substance, the learner should grab more toilet paper and follow the process again.
Repeat the process until the toilet paper has no colored substance on it, thus indicating that the surface is clean.
Reinforce accordingly.
Additional Notes
The trick here is to have the learner look at the toilet paper after they have wiped the surface. The learner should begin to use the toilet paper as a sign of whether or not a surface is clean or dirty. The goal is for the toilet paper to be the stimulus for whether or not the learner keeps wiping.
Talk the learner through the process, especially in the beginning stages.
Materials
Toilet Paper
Colored residue of some kind. Ex: Brown dry erase marker and dry erase board.
Research/Resources
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#4 Grabs toilet paper, wipes after bowel movement (w/ prompting)
How to Run
Immediately after the learner has finished a bowel movement, gain the attention and motivation of the learner.
Ask the learner to get some toilet paper. “Grab some toilet paper!”
Learner pull down toilet paper and tear off +/- 8 sheets.
If the learner can count with point-to-point correspondence, have them count 8 sheets and tear it off.
If they cannot count, have them pull the lowest hanging sheet to the floor (without it touching the ground), and tear it off.
Instruct the learner to wipe until they are clean. “Ok, wipe your bottom until it’s clean!”
Learner should begin wiping.
Once the learner wipes, they should check the toilet paper to see if there is excrement on it.
If there is, the learner should discard the toilet paper into the toilet and grab more toilet paper and follow the process again.
Prompt the learner to repeat the process until the toilet paper is free of excrement, thus indicating that the learner is clean.
Reinforce accordingly.
Additional Notes
The trick here is to have the learner look at the toilet paper after they have wiped the surface. The learner should begin to use the toilet paper as a sign of whether or not a surface is clean or dirty. The goal is for the toilet paper to be the stimulus for whether or not the learner keeps wiping.
Talk the learner through the process, especially in the beginning stages.
Materials
Toilet Paper
Toilet
Research/Resources
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#5 Grabs toilet paper, wipes after bowel movement (independently)
How to Run
Immediately after the learner has finished a bowel movement, learner pull down toilet paper and tear off +/- 8 sheets.
If the learner can count with point-to-point correspondence, they should count 8 sheets and tear it off.
If they cannot count, they should pull the lowest hanging sheet to the floor (without it touching the ground), and tear it off.
Learner should begin wiping.
Once the learner wipes, they should check the toilet paper to see if there is excrement on it.
If there is, the learner should discard the toilet paper into the toilet and grab more toilet paper and follow the process again.
The learner should repeat the process until the toilet paper is free of excrement, thus indicating that the learner is clean.
Reinforce accordingly.
Additional Notes
The trick here is to have the learner look at the toilet paper after they have wiped the surface. The learner should begin to use the toilet paper as a sign of whether or not a surface is clean or dirty. The goal is for the toilet paper to be the stimulus for whether or not the learner keeps wiping.
Materials
Toilet Paper
Toilet
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.
Problem? Question? Suggestion? We want to hear from you!
Intro to Reinforcer/Preference Expansion
Imitates Actions with Preferred Items
Performs Preferred Action with Preferred Item (LR)
Performs Action During Familiar Routines (LR)
Performs Actions with Uni-Functional Toys (LR)
Intro to Wiping 
Intro to Toileting 
Intro to Washing Hands
Labels Clean & Dirty