Classroom Based Intensive Toilet Training for Children with Autism Spectrum Disorder.

The study included only four participants, so results cannot be generalized to the broader population. The intervention package contained multiple components (sitting schedules, reinforcement, fluids, initiation training), making it impossible to determine which specific element caused the improvement. Bowel movements were not directly targeted or taught; they were treated as accidents if they occurred off-toilet. Follow-up was limited due to the pandemic, so long-term maintenance in home or community settings is unknown. The study was conducted in a classroom with high staff ratios (at least five staff present), which may not be feasible in typical school or home settings.

Do not assume the intensive multi-component package is necessary for all children. One participant became continent simply when his diaper was removed during baseline, suggesting that for some, the barrier is the diaper itself rather than a lack of training.