Resolving Barriers to Continence for Children with Disabilities: Steps Toward Evidence-Based Practice

Donnelly et al. (2024) read every toilet-training study that also listed why kids got stuck. They pulled out the fixes that lifted each roadblock. The paper is a map, not a new experiment.

They scoped BATT studies for children with autism, developmental delay, or intellectual disability. No fresh data, just a clear menu of what worked for accidents, refusal, or no self-initiation.

The review bundles dozens of small fixes into one place. You can flip to the section that matches the problem you see today and pick a tactic that already has data behind it.

No single package won. Instead, the authors show how to swap steps in and out until the child moves forward again.

Perez et al. (2020) showed a simple 30-minute sit schedule plus underwear and praise worked for eleven kids with ASD. Donnelly slots that plan under "mild accidents" and tells you to try it first.

Whitehouse et al. (2014) taught parents a 24-step home program; three of four preschoolers hit daytime dryness. Donnelly lists those same parent steps as the go-to when training stalls at home.

Osos et al. (2025) found most kids needed only a five-step package, but two needed a quick tweak. Donnelly turns that tweak list into a flow chart so you know when to add a contingent sit or extra fluids.

Perez et al. (2021) saw urinary gains spill over into better bowel habits and fewer problem behaviors. Donnelly uses that link to remind you to track all three domains, not just wet pants.

Toilet training often stops after the first failure. This review gives you a second, third, and fourth move without starting over. Keep the sheet handy, match the barrier you see to the fix listed, and run a quick probe. You will spend less time guessing and more time teaching the child to stay dry and independent.