Toilet Training Toddlers and Preschoolers

Study Description

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Brief Summary:

The investigators are interested in determining those procedures that prove to be most efficient and effective in facilitating continence (i.e., "dry pants" or the absence of soiled undergarments), appropriate eliminations (i.e., voids/stools in toilet), and independent requests/initiations to use the toilet. To assess the effectiveness of toilet training methods (procedures), data on toileting skills (in addition to each skill in a given child's curriculum) are collected across the school day (7:30 am-5:45 pm) by the classroom teachers. The primary dependent variables (toileting skills) are continence (i.e., absence of soiled undergarments), appropriate eliminations (i.e., the number of voids/stools made in the toilet), and independent/self requests (i.e., communication by the child with an adult to use the toilet). The toileting procedures are implemented by classroom teachers (undergraduate practicum students) and implementation is monitored by classroom supervisors (graduate teaching assistants). Procedural effectiveness is evaluated on a daily basis by the graduate teaching assistants and on an at-least-weekly basis by faculty supervisors.

Condition or disease	Intervention/treatment	Phase
Incontinence; Enuresis	Behavioral: Underwear/Differential Reinforcement	Not Applicable

Detailed Description:

First, the effects of the baseline toileting program are assessed. Baseline consists of prompting the child to use the bathroom approximately every 90 min (or more frequently if they independently request to do so). If the investigators observe low levels of continence, appropriate eliminations, and/or independent/self requests, components of the program are systematically altered to increase success. The ultimate goal is for the child to remain continent throughout the day, independently request (or initiate) toilet use, and appropriately eliminate in the toilet once in the bathroom. The following procedural modifications are made if high levels of success are not observed in baseline:

The first modification is to change the child's undergarment type. Specifically, underwear will be used, and it's effects will be evaluated to determine what effect (if any) underwear has on toileting performance.

The second modification is to conduct an individualized preference assessment to identify types of food and leisure items a given child prefers. This is done by having the child select items from an array (items selected based on direct observations of child and parent/teacher report) and allowing him/her access to the chosen item for a brief period of time. This will generate a list of preferred items/activities ranked in order of relative preference. Subsequently, the highest ranked items from the preference assessment will be arranged as reinforcers for continence, appropriate eliminations, and self-initiations. A third modification is to combine the above modifications to determine whether a combination of toilet training procedures enhances toileting performance (as compare to the implementation of individual toilet training procedures). This modification will be conducted while children wear underwear.

Study Design

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Study Description Study Design Arms and Interventions Outcome Measures Eligibility Criteria Contacts and Locations More Information

Study Type :	Interventional (Clinical Trial)
Actual Enrollment :	4 participants
Intervention Model:	Single Group Assignment
Masking:	None (Open Label)
Primary Purpose:	Treatment
Official Title:	Changing the Number of Accidents, Percentage of Appropriate Eliminations, and Number of Self-Initiations Across Toddlers and Preschoolers
Study Start Date :	November 2012
Actual Primary Completion Date :	July 2013
Actual Study Completion Date :	July 2013

Arms and Interventions

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Study Description Study Design Arms and Interventions Outcome Measures Eligibility Criteria Contacts and Locations More Information

Arm	Intervention/treatment
Experimental: Underwear/Differential Reinforcement; All subjects will wear underwear followed by wearing underwear while receiving differential reinforcement.	Behavioral: Underwear/Differential Reinforcement; Participants are going to be placed in underwear. Differential reinforcement will then be implemented.

Outcome Measures

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Primary Outcome Measures :

1. Change in the Mean Number of Accidents Across Children [ Time Frame: 2 months minus baseline ]

Secondary Outcome Measures :

1. Change in the Mean Percentage of Appropriate Eliminations Across Children [ Time Frame: 2 months minus baseline ]

Other Outcome Measures:

1. Change in the Mean Number of Self-initiations to Sit on the Toilet Across Children [ Time Frame: 2 months minus baseline ]

Eligibility Criteria

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Study Description Study Design Arms and Interventions Outcome Measures Eligibility Criteria Contacts and Locations More Information

Ages Eligible for Study:	18 Months and older (Child, Adult, Senior)
Sexes Eligible for Study:	All
Accepts Healthy Volunteers:	Yes

Criteria

Inclusion Criteria:

• Individual not yet toilet trained

Exclusion Criteria:

Contacts and Locations

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Study Description Study Design Arms and Interventions Outcome Measures Eligibility Criteria Contacts and Locations More Information

Locations

United States, Kansas
Edna A. Hill Child Development Center at the University of Kansas
Lawrence, Kansas, United States, 66045

Sponsors and Collaborators

University of Kansas

Investigators

Principal Investigator:	Brian D Greer, Ph.D.	Doctoral Student (Graduated)

More Information

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Study Description Study Design Arms and Interventions Outcome Measures Eligibility Criteria Contacts and Locations More Information

Responsible Party:	University of Kansas
ClinicalTrials.gov Identifier:	NCT01747343 History of Changes
Other Study ID Numbers:	HSCL-17816
First Posted:	December 11, 2012
Results First Posted:	September 1, 2014
Last Update Posted:	September 1, 2014
Last Verified:	August 2014

Keywords provided by University of Kansas:

Incontinence; Enuresis

Additional relevant MeSH terms:

Enuresis; Urinary Incontinence; Nocturnal Enuresis; Urination Disorders; Urologic Diseases; Behavioral Symptoms	Elimination Disorders; Mental Disorders; Lower Urinary Tract Symptoms; Urological Manifestations; Signs and Symptoms