JOURNAL OF APPLIED BEHAVIOR ANALYSIS 1971, 4, 173-181 NUMBER 3 (FALL 1971) TRAINING OF NORMAL AND RETARDED CHILDREN' KURT MAHONEY, R. KEITH VAN WAGENEN, AND LEE MEYERSON ARIZONA STATE UNIVERSITY

Early elements in an operant chain of toilet behaviors were trained in three normal infants and five retarded children. Following that, eliminative behaviors were conditioned by operant procedures. Each was equipped with an auditory signalling device that gave cues to the learner. Baseline behavior was recorded for a period of five days. The procedure for training consisted of two steps. First, a response was obtained through physical, verbal, and auditory prompts. Second, prompts were faded until the child responded in the pres- ence of the auditory signal. When the device was removed the child performed without the auditory prompt. Parents were instructed in a similar procedure to enhance generaliza- tion in the home. Seven of the eight subjects reached a criterion and maintained that be- havior during three criterion sessions.

Acceptable behavior includes the urinary component and began training walking to the at the appropriate their subjects when a reflex- event times, removing clothing, eliminating in the occurred. commode, and replacing clothing. It also in- The present experiment, investigated the cludes learning not to eliminate in clothing merits of training the subject to walk to the and not to eliminate at locations other than commode, in response to an auditory signal the commode. Parents often find this training, triggered by the experimenter, remove cloth- in all of its aspects, a difficult task (Spock, ing, sit on or stand in front of the commode, 1968). In common practice, parents do not replace clothing, and return to play without undertake the total task at once. They begin regard to eliminations. The rationale for the with the eliminative event by placing the procedure was this: since eliminating acts are child on the "potty" chair. If the child learns infrequently occurring reflexes under the con- to eliminate in the receptacle, then other as- trol of physiological processes in the child, pects of the task are undertaken. they permit only a limited number of condi- Rapidity of the training, however, may de- tioning trials to elaborate them as operants. pend on what the child learns first. Van Wag- We therefore first arranged for practice, in enen, Meyerson, Kerr, and Mahoney (1969), the presence of the auditory prompt, of all the have argued the merits of training behavior acts of toilet behavior. Once these behaviors in the same temporal order as its final form were under the control of the auditory and for close association of each of the ele- prompt, manual activation of the signal was ments in the chain of behavior. This means, terminated. At that time, a switch was thrown essentially, that the elements should all be that permitted the signal to originate from the practiced together in their approximate final flow of urine. The child was then expected to form. Van Wagenen et al., (1969) dealt with exhibit toileting behavior whenever reflex voiding was initiated. :This paper is based on the senior author's M.A. thesis. The authors gratefully acknowledge the gener- METHOD ous assistance given by the administrative staff and Board of Directors of the Mesa Association for Re- Subjects tarded Children School, especially Mrs. Darlene Two groups of subjects were selected from Schaumburg. We also thank William Martins who was incontinent children referred to the experi- responsible for modifications of electronic equipment. Reprints may be obtained from Kurt Mahoney, De- menter because their parents wanted them partment of Psychology, Mesa Community College, toilet trained. Selection criteria were as fol- Mesa, Arizona 85201. lows: (a) the child was ambulatory; (b) he was 173 174 KURT MAHONEY et al.

available for an 8-week period; (c) transpor- impedance transistor radio earphones (Lafay- tation was available for the child. ette, 99H2548). One earphone produced min- Group I was composed of three normal in- imally enough sound to replace the speaker fants (Subject 1, Subject 2, and Subject 3) all at its usual mounting on the receiver-signal- of whom had five to 10 words of speech. Sub- generator-package. The experimenter was ject 1 and Subject 2 were 20- and 21-month- able to hear the earphone signal across the old males, and they had good motor behavior. width of the training space. The second ear- Subject 3, 18 months old, was the only female phone was mated to a standard ear mold and in the study and she had poor motor behavior. placed in the subject's ear. The use of the Group II was composed of five male re- earphone reduced the possibility of audio in- tardates (Subject 4 through Subject 8) whose terference from irrelevant stimuli in the train- scores ranged from 10 to 45 on the Cattell In- ing space. fant Intelligence Scale. The first four subjects The 6-ounce receiver package ($30, Con- were 4 yr old. The fifth child, Subject 8, was trolaire SH-100, Controlaire Division of 9 yr old and profoundly retarded. Subjects 4 World Engines Incorporated, 8960 Rossash and 5 had excellent motor behavior; Subject Avenue, Cincinnati, Ohio 45236) was con- 5 was the only retarded child to have speech. tained in a 3 by 3 by 3.5 in. metal box (7.6 by His vocabulary consisted of three to five 7.6 by 9 cm) and powered by a 2.80-battery. words. Subjects 6 and 7 had poor motor be- The transmitter ($40, Controlaire Mark II) was havior and Subject 6 had a severe hearing loss housed in a 5 by 3 by 7 in. (12.7 by 7.6 by and paralysis of the right hand. 17.8 cm) metal box and had an average radi- ated power of between 150 and 175 milli- Setting watts. The receiver operated at a frequency The study was conducted at the Mesa As- of 27.095 megacycles and responded at a dis- sociation for Retarded Children School, Mesa, tance of 15 to 30 ft. A class "C" citizen's li- Arizona. A 20 by 17 ft room adjoining a toilet cense is required to operate this device facility was used for training. The room con- legally. tained a table, six chairs, and an assortment Figure 1 shows the transmitter and the re- of toys. The adjoining lavatory was equipped ceiver-signal-generator-package worn by the with a child-size tank-type commode, a port- subjects. able plastic , and a lavatory. Procedure Apparatus Baseline period. Each subject was brought Each subject in training wore a modified to the experimental room to establish a base- model of the signal-generator- pants re- line of urinary performance. Subjects were ported by Van Wagenen et al., (1969), which observed during daily 3.5 hr sessions for a mini- produced an auditory signal on the occur- mum of five days. They were clothed in cot- rence of urine flow. The device ($100, Mark ton pants and T-shirts only. On entering the II Toilet Trainer, Psytec, P. 0. Box 26006, experimental environment, each subject was Tempe, Arizona 85281) was modified in two shown the location of the commode and potty ways. First, it was coupled with a miniature chair. Pants were checked every 15 min and radio receiver, through which an audio alert changed when wet. could be triggered by the operation of an FM A baseline record was also kept of the num- transmitter. The experimenter, in operating ber of toileting responses. Adequacy of toilet- the radio transmiter, could cause the toilet ing response was rated at zero or one of 10 training device to sound its audio signal at behavioral levels of toileting adequacy and any time simply by the push of a button. This recorded on a data chart. These levels were in no way interfered with the automatic oper- identical to those used for recording experi- ation of the toilet training device as a conse- mental results. The untrained state of urinat- quence of a urinary event. The receiver and ing through the pants, without any attempt the transmitter, both operated on a single FM to walk to the commode, was represented on channel. the chart at Level 0. Level 10 on the chart was A second variation in the apparatus was the criterion performance of independently replacement of the usual speaker by two low walking to the commode, removing clothing, TOILET TRAINING OF NORMAL AND RETARDED CHILDREN 175 nal-generator-package and trained, individ- ually, in daily 1-hr sessions. Training was continued until all three of the component behaviors were brought under the control of the training conditions. The criterion for pro- ceeding to the next higher level of training was three consecutive appropriate responses, each within 3 sec after the onset of the audi- tory signal. The response was required to re- sult clearly from the sounding of the auditory signal. Parents were asked to withhold liquid and food 1 hr before each training session. These were withheld to increase their effectiveness as reinforcers and to minimize the chances for bowel elimination during the training ses- sions. Reinforcers consisted of the combina- tion of social praise and food. The procedure for training each of the pre- requisite behaviors consisted of two steps. First, a response was obtained through the use of physical, verbal, and auditory prompts. Second, prompts were faded until the child responded only in the presence of the auditory signal. Phase 1: teaching the subject to walk to the commode in response to the auditory sig- nal. The first step was to obtain the behavior Fig. 1. Positioning of the auditory receiving device on the child and the signal transmitter held by ex- of walking to the commode in response to perimenter. physical, verbal, and auditory stimuli. Toys were placed near the entrance to the lavatory eliminating in the commode, and replacing so as to occupy the subject at that location. pants. The experimenter activated the transmitter At irregular times throughout the baseline signal for 5 sec while saying: "Let's go potty," sessions, the experimenter approached each took the child by the hand, and led him to the subject and presented one of the following toilet. On subsequent trials, the speed of walk- commands: (a) "Go to the potty", (b) "Pull ing was increased, the experimenter moved your pants down", and (c) "Pull your pants further and further ahead of the child, and up" (after experimenter had pulled them toys were placed at increasing distances from down). The purpose of this procedure was to the facility. Walking to the lavatory was rein- obtain a pretraining measure of each subject's forced by the experimenter, who placed a con- response to the verbal instructions. The three sumable in the subject's mouth, and verbally commands were presented to each subject and gestually approved by clapping the hands three times per session for a total of 15 during and saying: "good boy!" or "good girl!" the 5-day period. Responses to the experi- The second step was to fade out the phys- menter's instructions were recorded. ical intervention and verbal prompts of ex- Prerequisite behavior training period. The perimenter when the auditory signal sounded. purpose of this period was to teach the sub- As before, experimenter activated the trans- ject the behavior sequence that typically pre- mitter but gradually reduced the use of verbal cedes the act of eliminating in a commode. prompts and hand gestures. In the process, The component behaviors included: (1) the experimenter progressively moved himself walking to the commode, (2) lowering pants, to a position behind the subject so that the and (3) sitting on, or facing, the commode. child eventually entered the lavatory first. The subject was equipped with a receiver-sig- Reinforcement was contingent upon walking 176 KURT MAHONEY et al. to the lavatory within 3 sec of the onset of the the signal to bring the subjects to the lavatory. auditory signal. When at the commode, the experimenter Phase 2: teaching the subject to lower his gradually reduced the physical assistance pants. Pants lowering was brought under the given female subjects in mounting the toilet control of verbal and physical prompts as in seat. For males, the experimenter gradually Phase 1. The signal was used only to bring the reduced the tension with which he held the child to the commode. When the subject was child in front of the commode. Reinforcement at the commode, the experimenter placed the was contingent upon independent sitting or child's hands on the sides of the training pants standing for a period of 30 sec. On successful near the leg opening and moved the hands fulfillment of the third phase, subjects were through the motions of pulling the pants brought together in the training space for the down. These hand movements were accompa- succeeding training sessions. nied by experimenter's instructions: "pull your pants down". Reinforcement was con- Elimination Training and Clothing Return tingent upon walking to the commode and When the subject completed the training, lowering training pants to a point just below he had demonstrated his ability to walk to the the knees. The pants were then pulled up by commode, remove pants, and assume the sex- the experimenter. appropriate stance. The last three phases in- The next step was to fade the verbal and volved bringing elimination and clothing re- physical prompts as follows: first, the experi- turn under the control of physical, verbal, and menter and subject together lowered the auditory prompts. pants. Second, experimenter gradually shifted Elimination training was limited by the fre- his hands up the subject's arms and so in- quency with which each subject "naturally" creased the distance between his own hands eliminated. To increase the total number of and those of the subject, until the child low- urinations occurring during a training session, ered his pants independently in response to subjects were trained in a group and offered the signal. As before, the pants were replaced liquids to drink at frequent intervals. As a re- by the experimenter. sult, the experimenter's time was occupied in Phase 3: teaching the subject to sit on the training or dispensing of liquid. The three or take the proper male stance normal subjects made up Group I while while facing it. The behavior of sitting on the Group II consisted of the five retarded chil- toilet seat or standing in front of it was dren. The liquid consisted of fruit punch and brought under the control of physical prompts was offered in a 5-ounce plastic drinking cup. in similar fashion to the earlier procedure. When eliminations occurred regularly at The auditory signal was generated manually the commode, the auditory signalling device as before and the reinforcer was delivered for was removed and the child demonstrated his walking to the toilet and lowering pants. The learning by "using the toilet" independently, experimenter then sat female subjects on the and without the auditory prompt. To initiate commode or potty or positioned male subjects elimination training, only one subject was in front of the commode. Subjects were re- equipped with the radio receiver. Radio re- strained at the commode by the experimenter ceivers were removed from all of the remain- who placed his hands around subjects' shoul- ing subjects. That single subject, who at that ders. On the first trial, subjects were re- time became the focus of training, was also strained for 10 sec. Gradually on the later equipped as before with the urinary-signal- trials, the restraining time was increased to a generator. When the experimenter could see maximum of 30 sec. Reinforcement was given that some other child was ready to eliminate if the subject sat for the required time on the and was not wearing a receiver, the exper- toilet or stood with pants lowered while fac- menter simply exchanged devices. This re- ing it. At the end of the time period, the ex- quired very little time and could be compared perimenter took the child off the commode, to moving an object from one pocket to an pulled up the pants, and connected them to other. The training continued as follows. the signal package. Phase 4: exposing subjects to the appropri- The second step was to fade the physical ate receptacle and inducing the consumption aid and restraint. The experimenter generated of liquids. When subjects had consumed a TOILET TRAINING OF NORMAL AND RETARDED CHILDREN 177 minimum of 10 ounces of liquids, the experi- hand movements were accompanied by the menter selected a subject for elimination experimenter's command: "Pull your pants training. The experimenter manually gener- up!" Reinforcement was contingent upon pull- ated the signal, as before, and the child was ing up the pants to cover the buttocks. reinforced for demonstrating the behaviors The second step was to fade the verbal and learned at prior levels. The purpose of the physical prompts supporting clothing return. experimenter-initiated sequence was to prac- As experimenter and subject together pulled tice earlier acquired behavior and to expose up the pants, the experimenter gradually in- the child to the commode during a period in creased the distance between his hands and which he had consumed a large quantity of those of the subject, until the child was pull- liquid. If, by chance, the child eliminated in ing up his pants independently. Reinforce- the receptacle during the 30-sec period of ment was contingent upon the subject pulling sitting on or standing at the commode, that up his pants independently. behavior was reinforced. On the other hand, Phase 6: practicing behavior chain without if the subject did not eliminate during this the support of the auditory signal. When a exposure period, the experimenter pulled the complete sequence of toileting responses had pants up and the child was allowed to leave been built up, it was necessary to strengthen the lavatory. If, when the subject was playing the control that the auditory signal had over and an elimination occurred in his pants the the previously learned behavioral sequence. auditory signal was produced automatically At this stage in training, the experimenter had and if the previously learned chain of re- learned to identify for each subject some spe- sponses was not manifested, the experimenter cific overt responses, which in the past often immediately induced them; i.e., walk to the preceded the act of eliminating. These re- commode, remove pants, and sit on or face sponses included, for example, a sudden in- toilet seat. However, at this level, reinforce- crease in motor activity, tugging at training ment was not given unless the child reiniti- pants, or holding of the genitals. When one ated the voiding response at the commode. or more of these responses appeared, the ex- Wet pants were removed without comment. perimenter initiated the auditory signal man- After each subject had eliminated in the ually with the expectation that the child receptacle at least once, in response to the might walk to the commode, remove clothing, experimenter-initiated auditory signal, elimi- eliminate in the receptacle, and replace cloth- nations in the pants were followed by the ex- ing. Reinforcement was contingent upon the perimenter saying: "NO! Go potty." It was as- child completing the entire chain in response sumed that the urine-initiated auditory signal to the auditory signal. and the verbal comments by experimenter The final act of training was to remove the would act to prompt the subject to respond in auditory signalling device and ensure compli- ways that he had demonstrated in the past. ance to the training regime without it. On full Again, reinforcement was contingent upon and correct completion of the third consecu- some urine in the receptacle. tive behavior sequence, in response to the Phase 5: teaching subjects to pull up their auditory signal, the device was removed. pants. The training procedure at this phase Further trials, without the device, were main- was similar to Phase 2. The first step was to tained by continuing the practice of offering bring pants lowering under the control of the child quantities of liquid. Reinforcement physical and verbal prompts. The signal was was then contingent upon the subject initiat- generated by experimenter or urine flowing ing independent performance of the total se- in the pants and reinforcement was given for quence of toileting behavior without signals walking to the commode, lowering pants, tak- or prompts. ing the appropriate position at the commode, Sessions to confirm training and ensure the and urinating in the receptacle. After an elim- transfer. The last three training sessions ination in the receptacle, the experimenter served three functions. First, they provided took the subject's hands and placed them on a fixed period of time that was used to mea- the sides of the training pants near the waist- sure the stability of the subject's toilet be- band and the pants were pulled up by the havior and to compare it with his entering experimenter and the subject together. These behavior. 178 KURT MAHONEY et al. Second, the sessions were used to teach the spaced telephone conversations between the four verbal subjects the word "potty". As the experimenter and each parent. subject walked, independently, to the com- mode he was interrupted by the experimenter who said: "where are you going?" If the sub- RESULTS ject responded with the word "potty", which The individual acquisition curves for nor- had been paired with trips to the commode mal subjects of Group I and retarded subjects during earlier training, he was released and of Group II are shown in Fig. 2 and Fig. 3 re- allowed to continue on to the lavatory. How- spectively. Seven of the eight subjects reached ever, if the child did not respond, the experi- the criterion level during the training sessions menter prompted him to say the word. and maintained that behavior during three Third, this time was used to instruct the criterion test sessions. Normal, younger sub- parent to institute a similar training proce- jects attained the criterion performance in an dure at home, in an attempt to achieve gener- average of 29 hr and 118 trials. Much of the alization of the behavior. During this instruc- training time was devoted to attentions unre- tion period, the subject's parent was brought lated to toilet training. The older, mentally into the experimental room and, while ob- retarded subjects reached criterion in 29 hr serving her child's performance, she was in- and 262 training trials. structed in aspects of the procedure that did not require the signalling device. Baseline Sessions None of the subjects walked to the com- Follow-Up mode or responded appropriately to all three After the formal training sessions were com- commands. Subject 4 responded to two of the pleted, one parent from each group was se- 15 presentations by pulling his pants down lected to provide information on her child's and up. Subject 5 correctly lowered his pants progress in the home. On the basis of an ex- three times and pulled them up twice. The pressed willingness to provide this informa- number of times Subjects 1 to 8 urinated on tion, the mothers of Subject 2 and Subject 8 the floor or in their pants during the five ses- were selected. Over a period of six months, sions was as follows: 13, 12, 22, 15, 28, 12, 11, information was obtained during 13 uniformly and 19 times. None of the subjects urinated

10 Walk to commode, lower pants, urinate in commode, pull pants up. No prompts or auditory signal. 9 Walk to commode, lower pants, sit on or stand in front of commode, urinate in commode, pull pants up, in response to auditory signal. 8 Walk to comrade, lower pants, sit on or stand in front of commode, urinate in commode, pull pants up, in response to auditory signal and prompts. 7 Walk to commode, lower pants, sit on or stand in front of commode, urinate in commode, in response a to E or urine initiated auditory signal. j 6 Wall to commode, lower pants, sit on or stand in h front of commode, in response to auditory signal. J S Walk to commode, lower pants, sit on or stand in front of commode, in response to auditory signal and prompts. 4 Walk to commode, lower pants in response to audi- tory signal. 3 Walk to commode, lower pants in response to audi- tory signal and prompts. 2 Walk to commode, in response to auditory signal.

1 Walk to commode, in response to auditory signal and prompts.

5 10 15 BLOCKS OF TEN TRIALS Fig. 2. Acquisition of toilet behaviors for normal subjects. Each point on the curve represents the average level of performance for a block of trials. Numbers with arrows represent the cumulative hours of training. The cri- teria for each level of performance are listed to the left of the top graph. TOILET TRAINING OF NORMAL AND RETARDED CHILDREN 179

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Fig. 3. Acquisition of toilet behaviors for retarded subjects. Each point on the curve represents the average level for a block of trials. Numbers with arrows represent the cumulative hours of training. in the commode at any time during the base- 9 represent qualitative approximations to the line observations. terminal behavior at level 10, but they do not represent quantitatively equal intervals. Each Training Sessfoms plotted point is the average level of perform- The cumulative number of trials required ance over a block of 10 training trials. In addi- for each subject to attain the various levels of tion, the cumulative hours are shown on the performance are presented in Fig. 2 and 3. A curves at levels 2, 4, 6, and 10. description of each behavior level appears Normal subjects. Subject 1 reached level- with the graph for Subject 1. Levels 1 through 10 performance in 19 training hours with a 180 KURT MAHONEY et al. total of 84 trials of various kinds. Before the Subject 7 was the only subject who failed end of the first hour of training, this subject to attain the performance required at level 10. walked to the commode in response to the After 19 hr and 379 training trials, this subject auditory signal and after the third hour he had acquired the behaviors of level 7. Fre- lowered his pants and took the appropriate quent fluctuations between levels occurred. stance. The first urination event in the com- The experimenter observed that each voiding mode occurred during the fourth hour of response was limited to a few drops of urine. training. At the beginning of the thirteenth Increasing the child's liquid consumption session, the auditory device was removed and, tended to increase the frequency of urinations in addition to the cotton briefs, the subject without influencing their volume. was clothed in a pair of overshorts and a shirt. Subject 8 spent the major portion of the Subject 2 required 122 trials and 27 hr to training sessions sitting motionless, with legs attain level-10 performance. The plateau that crossed, on the floor. A total of 436 trials occurred for Subject 2 at level 3 is representa- spaced over 48 hr of training were required tive of a difficulty this subject had in learning before Subject 8 demonstrated the behavior to lower his training pants. sequence required at level 10. To teach this Subject 3 was the only female subject. The child the first step of the toileting chain, experimenter had difficulty in conditioning namely to walk to the lavatory in response to this subject to remain seated on the potty the auditory signal, required 168 trials. chair for the time required. The difficulty is During urination training at level 7, Subject indicated by the number of trials between 8 did not consume enough liquid to void; and, levels 5 and 6. The first elimination event in in consequence, a diuretic drug was intro- the commode occurred during the eighteenth duced. The drug, a polythiazide, was pre- hour of training. scribed by the family's physician and was ad- Retarded subjects. Subject 4 reached level ministered by the parent 1 hr before each 10 on the one hundred and eighty-eighth trial session. A 2-milligram tablet increased the after 17 training hours. The graph for this number of urinations but it also caused the subject shows that- he emitted level-6 re- subject to regurgitate. Reducing the dose by sponses for a lengthy period of time. Low half eliminated the regurgitating without density of eliminations, which kept Subject 4 materially reducing the frequency of voiding. at level 6, was corrected by offering the child greater quantities of liquid. The first voiding Criterion Test Sessions event at the commode occurred during the Over the three days of test sessions, the ninth hour of training. seven subjects emitted 90 perfectly performed Subject 5 walked into the facility, removed responses and four error responses. pants, and stood appropriately in front of the commode after 3 hr of training. One hundred Follow-Up Sessions and fifty-seven trials at level 7 occurred before The parent of one subject from each of the this subject voided in the commode. Twenty- two groups was selected to provide informa- two hours were required to reach criterion tion on the child's progress in the home. This behavior. period extended for six months after the for- Subject 6 had a hearing impairment and a mal experiment terminated. The parent of partial paralysis of the left hand. Sounding Subject 2, a normal child, reported that this the auditory signal prompted no observable subject eliminated in places other than the response. Attempts to modify the device, in commode approximately four times per week an effort to obtain a response, proved futile. during the first post-training month. During By substituting a gentle tap on the subject's the next five months, errors decreased and by forehead, in place of the auditory signal, the the end of the sixth month, Subject 2 averaged training proceeded satisfactorily. The paraly- only one inappropriate response per week. sis interfered with pants manipulation. This More importantly, these "accidents" generally was corrected by clothing the subject in larger occurred when the child was playing out of size pants which he could manage. This sub- the house or on a family outing. ject reached criterion in 30 training hours dur- Subject 8 was a profoundly retarded boy. ing which 262 trials were emitted. At the end of the first month, the parent re- TOILET TRAINING OF NORMAL AND RETARDED CHILDREN 181 ported that this child averaged four inappro- ing until the child had learned to walk to the priate responses per week. This average did commode, lower pants, and assume the sex not decrease during the remaining five appropriate stance. The results indicate that months. At the end of the sixth month, the the method was effective in training seven of experimenter visited the home and observed the eight subjects. Acquisition data for each the child for a period of 3 hr. The experi- child were not limited to elimination training, menter observed that the parent had begun but obtained for the entire chain of toilet to prompt the subject to go to the lavatory. behavior. Consequently, during the periods when the Economic consideration of time and effort parent was not present to prompt the child, will not be ignored by those managing insti- he did not move to a toilet before urinating. tutions for the retarded. Long waiting vigils Admonitions to the parent to stop prompting in anticipation of urinary events are uneco- had no effect on the parent's behavior. nomical and destructive of the motivations of caretakers. Prior training in which high den- sity of practice trials can be carried out with- DISCUSSION out dependence on physiological states can Complete toileting behavior includes a avoid some' of these difficulties, as this study complex chain of behaviors. However, the has shown. Slight procedural change and less authors' review of literature revealed that elaborate equipment would make the method researchers have been concerned primarily usable by a parent in the child's natural home. with the eliminative aspect of this chain. Since the occurrence of reflex voiding is diffi- cult to predict, persons studying toilet behav- REFERENCES ior have concentrated their efforts in devising Baumeister, A. A. and Klosowski, R. An attempt to reliable procedures for detecting eliminations group toilet train severely retarded patients. Mental Retardation, 1965, 3, 24-26. and reinforcing the proper ones (Dayan, Dayan, M. Toilet training retarded children in a 1964; Baumeister and Klosowski, 1965; Hun- state residential institution. Mental Retardation, ziak, Maurer, and Watson, 1965; Giles, and 1964, 2, 116-117. Wolf, 1966). Ellis, N. R. Toilet training the severely defective pa- tient: An S-R reinforcement analysis. American Ellis (1963) is frequently cited for having Journal of Mental Deficiency, 1963, 68, 98-103. suggested a procedure for determining a Giles, D. K. and Wolf, M. M. Toilet training institu- child's "natural" eliminatory behavior, and tionalized, severe retardates: an application of op- using this information in setting up a sched- erant behavior modification techniques. American ule for placing the child on a toilet. Giles and Journal of Mental Deficiency, 1966, 70, 120-124. Hunziak, M. M., Maurer, R. A., and Watson, L. S. Wolf (1966) used this suggestion in training Operant conditioning in toilet training of severely mentally retarded children. On the other mentally retarded boys. American Journal of Mental hand, Van Wagenen et al., (1969) suggested Deficiency, 1965, 70, 120-124. that training take place only when the child Spock, B. Toilet training after eighteen months. is in the process of eliminating. Im- Redbook, July, 1968, 22-27. actually Van Wagenen, R. K., Meyerson, L., Kerr, N., and mediate detection of an event was possible by Mahoney, K. Field trials of a new procedure for equipping each child with a urine-sensing toilet training. Journal of Experimental Child Psy- auditory signalling device. chology, 1969, 8, 147-159. The purpose of this study was to investigate Received 15 October 1970. a procedure that deferred elimination train- (Revised 30 June 1971.)