Evaluating bowel movements, self‐initiations, and problem behavior with the emergence of urinary continence
Teaching urinary continence in kids with ASD seems to generalize to improved bowel movements, self-initiations, and less problem behavior.
01Research in Context
What this study did
Perez et al. (2021) looked back at clinic charts of kids with autism who finished a full toilet-training program.
They asked: when a child learns to stay dry, do bowel habits, self-initiations, and problem behavior also improve?
No new treatment was given; the team just scored old data for these extra outcomes.
What they found
Dry days and dry nights rose together.
At the same time, kids had more regular bowel movements, asked to use the toilet on their own, and showed fewer tantrums or self-harm.
The link was strong: continence gains came with bonus gains in body comfort and calm behavior.
How this fits with other research
Perez et al. (2020) used the same simple package a year earlier—30-minute sits, underwear, praise—and only tracked urinary success. The 2021 paper adds the good news that bowels, initiations, and behavior get better too.
Osos et al. (2025) later polished the package for preschoolers and kept it punishment-free. Three of five children stayed dry with the standard plan; two needed a quick tweak. Both studies show the same core method works; Osos just trimmed the steps for younger kids.
Slaughter et al. (2014) and Kurokawa et al. (2021) only asked parents about GI pain and behavior. They found more tummy trouble linked to more irritability. Perez et al. (2021) go a step further—treating continence may actually calm both the gut and the behavior.
Why it matters
If you run a toilet program, watch for extra wins. Track bowel patterns, spontaneous requests, and problem behavior alongside accidents. When parents see progress in all areas at once, buy-in grows and you can fade prompts faster.
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02At a glance
03Original abstract
Much of the research evaluating toilet training interventions for children with ASD has focused on urinations as the primary dependent variable. As a result, the effects that toilet training interventions targeting urinations may have on other related dependent variables remains unclear. We conducted a retrospective analysis of data obtained by Perez et al. (2020), who evaluated the effects of a treatment package on urinary continence in children with ASD. We examined the relation between the emergence of urinary continence and multiple nontargeted dependent variables: bowel movements, self-initiation correspondence, percentage of appropriate urinations that were self-initiated, self-initiation rate, and problem behavior. Results showed that improvements in urinary continence were strongly correlated with improvements in all nontargeted dependent variables. Implications for future research and clinical practice are discussed.
Journal of Applied Behavior Analysis, 2021 · doi:10.1002/jaba.837