Behavioral Intervention to Eliminate Socially Mediated Urinary Incontinence in a Child with Autism

ABSTRACT

We report the case of an 11-year-old boy with autism who demonstrated urinary incontinence that appeared to be maintained by social contingencies (adult attention and escape from activity “demands”). Although he wet himself frequently, he also used the bathroom appropriately and made many self-initiated toileting requests. Intervention was implemented at a day-school by (1) having the boy wear a disposable diaper so immediate clothes changing was not required (escape extinction), (2) limiting requests to use the bathroom, (3) withholding attention contingent on incontinence, and (4) praising in-toilet urinating. Another element of intervention was the systematic fading of the diaper. Urinary incontinence was eliminated, the diaper withdrawn, and improvement maintained 6 months post-intervention.

KEYWORDS:

• Urinary incontinence
• toilet training
• developmental disabilities
• functional behavioral assessment
• child autism