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Toilet School for Children with Failure to Toilet Train

Comparing a Group Therapy Model with Individual Treatment

Law, Evelyn MD; Yang, Jeffrey H. MD; Coit, Margaret H. MPH; Chan, Eugenia MD, MPH

Journal of Developmental & Behavioral Pediatrics: April 2016 - Volume 37 - Issue 3 - p 223–230
doi: 10.1097/DBP.0000000000000278
Original Articles

Objective: This study compared the toileting outcomes of children participating in Toilet School group therapy with children in individual treatment.

Method: All children in this study failed conventional toilet training and were 4 to 6 year, 11 month old. Cases were 63 children who attended a 6-week Toilet School group therapy with their parents. Controls were 62 children who were seen in individual treatment in the same tertiary care program and were matched to cases based on treatment dates. We analyzed the number of toileting benchmarks met for cases and controls. We used a stepwise linear regression model to investigate the contribution of child and family factors in predicting the number of toileting benchmarks met.

Results: Compared to controls, cases achieved significantly more toileting benchmarks (p < .001) at the end of Toilet School, were more likely to have bowel movements in the toilet (p = .001), and required fewer subsequent visits until completion of toilet training (p = .013). Similarly, at the seventh provider encounter for both controls and cases, the cases continued to achieve significantly more toileting benchmarks (p < .001) and were more likely to have bowel movements in the toilet (p = .002) compared to controls. After adjusting for age, gender, neighborhood poverty level, and number of total clinical visits for fecal incontinence, treatment grouping was the only independent variable that predicted toileting progress.

Conclusion: For children with failure to toilet train, group treatment involving both the child and the family results in greater improvement in toileting outcomes than individual treatment.

*Division of Developmental Medicine, Boston Children's Hospital, Boston, MA;

Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore;

Child Development Unit, Department of Paediatrics, Khoo Teck Puat-National University Children's Medical Institute, National University Health Systems, Singapore;

§Division of General Pediatrics, Children's Hospital of Los Angeles, Los Angeles, CA;

Department of Pediatrics, Keck School of Medicine of University of Southern California, Los Angeles, CA;

Department of Pediatrics, Harvard Medical School, Boston, MA.

Address for reprints: Evelyn Law, MD, Department of Paediatrics, 1E Kent Ridge Rd, National University Health Systems Tower Block Level 12, Singapore 119228, Singapore; e-mail:

Disclosure: The authors declare no conflict of interest.

Received August , 2014

Accepted January , 2016

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