Continuity of Treatment: Toilet Training in Multiple Community Settings

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Abstract
This study investigates the toilet training of four severely handicapped autistic children who regularly participated in a number of diverse community settings. In the context of a multiple baseline design, the children were first provided a systematic toilet training program in only some of the environments. In a subsequent “continuity” condition, the same toilet training program was systematically and simultaneously implemented within all of the children's environments. Results showed no consistent trends towards acquisition when training was provided in only some of the settings, even when the program was in progress for over two years. However, the continuity approach which coordinated all of the children's daily activities produced immediate and steady gains in successful toileting. This success was evident with children who had long histories of unsuccessful training attempts as well as with a child who had no previous exposure to toilet-training programs of any kind, These data are discussed in terms of the need for and benefits of continuity of treatment across settings for severely handicapped individuals.