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.

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

Skill Possibilities

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.

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.

Intro to Wiping

Intro to Toileting

Intro to Washing Hands

Labels Clean & Dirty

Composite Skills

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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