Development of diurnal bladder control in severely and profoundly mentally handicapped residents.

Doctors watched 198 adults with severe or profound intellectual disability for seven years. No one taught toilet skills. Staff simply recorded wet pants checks twice a day.

The team wanted to know if daytime bladder control would improve on its own over time.

Wet pants slowly became a little less common. The change was real but tiny—most residents still needed diapers every day.

Growth without training is possible, yet the payoff is barely noticeable.

Cohen et al. (2018) also tracked daily data in the same kind of home. They showed sleep ups and downs predict next-day behavior problems. Both papers prove long-term records can spot small patterns in very disabled clients.

Nordahl et al. (2016) took the opposite path. They used ABA shaping and rewards so kids with ASD and ID could lie still for an MRI. Their quick, clear gains clash with Repp et al. (1992) tiny slow change. The difference is active teaching versus wait-and-see.

Balboni et al. (2022) made a faster IQ test for the same group. Their work reminds us good measurement matters whether we watch toileting or diagnose disability.

If you run a residential program, do not expect big toilet gains without a plan. Seven years bought only a small dip in wet pants. Pair this fact with Nordahl’s lesson: active ABA steps can give faster, larger wins. Start an intensive toileting protocol if continence is a goal—waiting is not enough.