Although the challenges of Toilet Training in children and adolescents with Autism Spectrum Disorder (ASD) are well-known, to date still doesn’t exist a formal procedure for toilet rehabilitation of this patients. (1) Aims of the study were to develop a protocol for the Toilet Training in subjects with ASD and to explore its effectiveness in increasing continent voids, bladder control and expanded periods of time between two micturition.

We developed a Toilet Training protocol for ASD subjects, including the follow components: (i) removal of diapers, (ii) scheduled time interval for bathroom visits, (iii) positive reinforcement of micturition in the toilette, (iiii) gradual increase time intervals between two micturition. Correct micturition was defined as the release of urine while seated on the toilet. Patients were evaluated at baseline with urinalysis and culture, abdomen ultrasound and 7- days bladder diary (including successfully voiding and accidents); follow- up was every week with the bladder diary evaluation. Patient’s parents were instructed to perform the toilet program. Patients were taken to the toilet on a schedule and reinforced when they successfully voided into the toilet. At week 1, the scheduled time for bathroom visit was every 40 minutes, and increased by 5 minutes each week, until reaching 90 min. The program included negative reinforcement in case of overtime micturition.  The protocol finish at 6 months.

Twenty subjects (11 males, 9 females) were included in the protocol. Median age was 13 years (range: 7- 19 y.o.). All patients were cognitively whole and 4 of them were non- verbal. Intervention took place in the home of each participant. At baseline, all patients had no or < 30% of successful voids in the toilet. No patients had urinary tract infections (UTIs) or post- void residual volume (PVR) >50 mL. All patients had diapers at baseline; at the end of teaching 2/20 (10%) of subjects had still diapers (from 6.1 ± 1.2 to 2.8 ± 1.1 pads/die; p< 0.00) and all patients increased the number of voids in the toilet (baseline- last follow-up [mean ± SD]: from 2.6 ± 1.3 to 7.2 ± 1.8 urinations/ day; p< 0.00). The protocol was well tolerated and effective for all patients and 15/20 (75%) of participants totally followed the micturition timing of the protocol.

Toilet training is an important milestone for children and parents for several reasons, including independence, safety, and social acceptance. (2) Limited studies have reported success in Toilet Training individuals with ASD. Our work is among the few existing study and with the highest number of patients included.

This innovative study demonstrated in one of the largest samples that our Toilet Training protocol is effective in training children and adolescents with ASD.

Gubbiotti M, Balboni G, Bini V, et al. Bladder and bowel dysfunction, adaptive behaviour and psychiatric profiles in adults affected by autism spectrum disorders. Neurourol Urodyn. 2019 Sep;38(7):1866-1873.
Gubbiotti M, Balzarro M, Zoccante L, et al. National Survey on Bladder and bowel dysfunctions in Autism Spectrum Disorder population. Front. Psychiatry. 2024; 15:1140113

Continence 12S (2024) 101547
DOI: 10.1016/j.cont.2024.101547