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Toilet Training Toddlers and Preschoolers

This study has been completed.
Information provided by (Responsible Party):
University of Kansas Identifier:
First received: December 7, 2012
Last updated: August 21, 2014
Last verified: August 2014
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 Intervention
Behavioral: Underwear/Differential Reinforcement

Study Type: Interventional
Study Design: Intervention Model: Single Group Assignment
Masking: 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

Resource links provided by NLM:

Further study details as provided by University of Kansas:

Primary Outcome Measures:
  • Change in the Mean Number of Accidents Across Children [ Time Frame: 2 months minus baseline ]

Secondary Outcome Measures:
  • Change in the Mean Percentage of Appropriate Eliminations Across Children [ Time Frame: 2 months minus baseline ]

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

Enrollment: 4
Study Start Date: November 2012
Study Completion Date: July 2013
Primary Completion Date: July 2013 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
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.

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.


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

Inclusion Criteria:

  • Individual not yet toilet trained

Exclusion Criteria:

  Contacts and Locations
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Please refer to this study by its identifier: NCT01747343

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

Responsible Party: University of Kansas Identifier: NCT01747343     History of Changes
Other Study ID Numbers: HSCL-17816
Study First Received: December 7, 2012
Results First Received: July 8, 2014
Last Updated: August 21, 2014

Keywords provided by University of Kansas:

Additional relevant MeSH terms:
Urinary Incontinence
Nocturnal Enuresis
Urination Disorders
Urologic Diseases
Behavioral Symptoms
Elimination Disorders
Mental Disorders
Lower Urinary Tract Symptoms
Urological Manifestations
Signs and Symptoms processed this record on April 26, 2017