A rapid method of toilet training the institutionalized retarded.
Four days of fluids, alarms, and praise can wipe out daytime accidents in profoundly impaired adults.
01Research in Context
What this study did
Herman et al. (1971) tested a four-day toilet-training package on nine profoundly retarded adults living in a state institution. Staff gave the adults extra fluids, clipped on a wetness alarm, and praised every success.
If the alarm sounded, the adult walked to the toilet, cleaned up, and practiced five extra trips. Accidents dropped the same day.
What they found
Daytime accidents fell to almost zero after the short program. The adults stayed dry without diapers or reminders.
Staff saved hours of clean-up time and the residents gained dignity and freedom.
How this fits with other research
Herman et al. (1971) and Herman et al. (1971) both used instant wetness alarms, but one worked with adults and the other with children. Same year, same idea, same good results.
Raslear et al. (1992) followed adults for ten years and found the gains stuck. The 1971 method started it; the 1992 study proved it lasts.
Spangler et al. (1984) moved the idea into a nursing home. They added a hydration cart for bed-bound elders. Accidents and dehydration both dropped, showing the package travels across ages and settings.
Why it matters
You can copy this four-day plan in any group home or day program. Extra drinks, a cheap alarm, and quick praise give near-zero daytime accidents even for the most impaired clients. Less laundry, more dignity, and staff time freed for teaching other skills.
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02At a glance
03Original abstract
Incontinence is a major unsolved problem in the institutional care of the profoundly retarded. A reinforcement and social analysis of incontinence was used to develop a procedure that would rapidly toilet train retardates and motivate them to remain continent during the day in their ward setting. Nine profoundly retarded adults were given intensive training (median of four days per patient), the distinctive features of which were artificially increasing the frequency of urinations, positive reinforcement of correct toileting but a delay for "accidents", use of new automatic apparatus for signalling elimination, shaping of independent toileting, cleanliness training, and staff reinforcement procedures. Incontinence was reduced immediately by about 90% and eventually decreased to near-zero. These results indicate the present procedure is an effective, rapid, enduring, and administratively feasible solution to the problem of incontinence of the institutionalized retarded.
Journal of applied behavior analysis, 1971 · doi:10.1901/jaba.1971.4-89