Toilet Training in Less Than a Day is the title of a book by Nathan H. Azrin and Richard M. Foxx, two psychologists who first developed their method for children with disabilities.
As far as I can tell, virtually all the “fast-track" approaches to potty training (including the approach advocated by television's Dr. Phil) are based on Azrin and Foxx’s ideas.
For this reason, let’s take a detailed look at their toilet training techniques.
teaching through pretend play
positive reinforcement (food rewards)
practice drills, and
overcorrecting for accidents.
Azrin and Foxx also emphasize the importance of timing. Not all kids are ready for their approach. In their book, Azrin and Foxx specify that kids should be 20 months or older, and they should meet several developmental criteria. In particular, kids should be able to
sit up by themselves
stay dry for a couple of hours at a time
recognize a full bladder
point to body parts that you name
retrieve objects for you, and
follow simple instructions like “put the doll on the potty."
Kids should also be able to pull a pair of loose-fitting underpants up and down by themselves. (For tips on how to help your child learn these skills, see my article on potty training preparation.)
There are medical and emotional criteria, too. Parents should also avoid these toilet training techniques if children are ill, constipated, or uncooperative.
Last but not least, Azrin and Foxx warn that their toilet training techniques require a lot of preparation. The title of their book (“Toilet training in less than a day") is a bit misleading. To be successful, a parent must do his homework.
So—as you read my brief summary below—-keep in mind that this is not a substitute for reading their book. If you want to try fast-track toilet training techniques, the Devil is in the details. Without adequate preparation, you risk failure. And even worse—you risk making your child resistant to other attempts at potty training.
Bottom line? No parent should attempt this method without first studying Azrin and Foxx’s book.
Azrin and Foxx’s toilet training techniques
When your child is ready, devote a day (4-6 continuous hours) to training. You will need to set up a training area with a potty chair, a doll with a removable diaper, food treats, and drinks. The room you use should be large enough to play in, and relatively easy to clean up. The authors suggest the kitchen. The authors also specify that you use a doll can drink and “urinate" (pass water that has been poured in its mouth). However, you can probably use an ordinary doll if you are prepared to handle the special effects with sleight-of-hand.
Banish all distractions, including siblings and other family members. Dress your child in loose-fitting training pants (and no other layers of clothing) and encourage him to drink plenty of fluids throughout the session. You want him to pee frequently.
Training consists of two phases. In the first phase, you use the doll to demonstrate the potty routine. Give the doll a drink. Then tell your child that the doll has to pee. Guide your child through the process of removing the doll’s diaper, sitting the doll on the potty, waiting for the doll to pee, and praising and rewarding the doll for doing so. Continue with other aspects of the potty “script," like emptying the doll’s “urine" from the potty chair and washing hands. Then you check the doll’s diaper. If the diaper is dry, the doll gets another reward. If it’s wet, you explain that big kids don’t wet their pants.
“Overcorrect" for this mistake by guiding the doll through a quick practice version of the potty routine. Encourage your child to guide the doll himself.
Azrin and Foxx suggest that you repeat the doll demonstration trials until your child understands the steps. This usually takes no more than one hour (Azrin and Foxx 1974, p. 68). Then you start the second phase of training—putting your child through the paces. What you and your child did with the doll, you now do with your child.
The key to this potty training method is positive reinforcement and overcorrection. When kids get it right, they are rewarded. When they get it wrong (wet their pants) they perform practice drills.
Do these toilet training techniques work?
When Azrin and Foxx tested their method on 34 children, the average child finished training in 3.9 hours and experienced a 97% decrease in accidents the week after training. (Foxx and Azrin 1973).
Other studies have reported somewhat less spectacular outcomes, but the results are still good.
• One of the few randomized, controlled studies of toilet training techniques compared Azrin and Foxx’s “toilet training in less than a day" approach (TTLD) to an alternative potty training method advocated by Dr. Benjamin Spock. The researcher found that TTLD was significantly more effective. Kids were more successful and had fewer accidents. In addition, parents rated TTLD as the more helpful potty training method (Candelora 1977).
• Another study—one that did not randomly assign children to treatment—tracked kids trained at home. The researcher reported a 74% success rate for kids under 25 months. Among kids over 25 months, the success rate was 93%. Eight weeks after training, kids averaged less than one accident per day (Butler 1976).
• Another, much smaller study assigned children to be trained by either by their own mothers or by an experienced trainer. Four of the 5 children trained by the practiced trainer were successful. Only 2 of the 5 kids trained by their own moms were successful. Because of the small sample size, the results were not statistically significant (Matson and Ollendick 1977).
Overall, these results suggest that Azrin and Foxx’s toilet training techniques are pretty effective. Compared with other options, these techniques are also associated with relatively quick results and an earlier age of completion. For example, a recent study reports that kids who were trained using another method (the so-called “child-oriented approach"--reviewed here) didn’t complete training until they were between 3 and 4 years old (Taubman et al 2003).
However, parents should keep in mind how little we know about the relative effectiveness of different toilet training techniques. To date, most studies of toilet training methods have focused on Azrin and Foxx. We know less about the effectiveness of alternative toilet training techniques. And very few studies meet the highest standards of experimental rigor.
What we don't know
As of 2006, researchers at the University of Alberta Evidence-based Practice Center were able to find only three randomized, controlled, studies of toilet training methods (Klassen et al 2006).
And only one of these studies (Candelora 1977) compared the effectiveness of two different methods—the “toilet training in less than a day" method v. the Dr. Spock method.
As the University of Alberta researchers note, more studies are needed to determine if any one potty training method is better than the rest. We also need more research to investigate
how the individual characteristics of parents and children might affect potty training success, and
whether or not there are any long-term, adverse side effects associated with particular toilet training techniques.
The first question may be crucial—especially for Azrin and Foxx approach to toilet training. Check out the customer reviews on Amazon.com, and you’ll see for yourself. This is a potty training method that people either love or hate.
I suspect it depends on how closely parents follow Azrin and Foxx’s toilet training techniques. If parents are unprepared or uncomfortable with the approach, they are not likely to succeed. In the study mentioned above, parents were less successful applying the approach than was an experienced trainer. And—in another study—the researcher found that older, more tolerant mothers were more likely to succeed (Candelora 1977). Perhaps these parents were more confident and relaxed during the training process.
It probably also depends on whether or not your child is motivated and cooperative. Some parents have reported that their children became upset during the training. If this happens, it’s best to back off. Pushing an upset, uncooperative child can cause behavioral problems. Azrin and Foxx are careful to note that parents must tailor the toilet training techniques to the needs of their child. For some families, this method may feel too regimented.
Other fast-track toilet training techniques
As noted above, other “quickie" approaches to training draw heavily on Azrin and Foxx’s toilet training techniques.
In Potty Train Your Child in Just One Day: Proven Secrets of the Potty Pro (2006), Teri Crane outlines a three-step program that includes role playing with a doll, practice runs with your child, and a “potty party."
Azrin and Foxx’s techniques also show up in Narmin Parpia’s Potty Training in One Day: A Guide for Today's Parents (2006).
This book is part of a system that includes a special potty, wetting doll, and training pants.
Are these methods any more or less successful than Azrin and Foxx’s original formula? Unfortunately, we don’t know. Nobody has put them to a scientific test.
What about the bare bottom?
Finally, for parents who dislike the regimentation associated with most “fast-track" toilet training techniques, I should mention this alternative:
Let kids run around naked for a few hours, and wait for them to figure out for themselves when to use the potty.
Pediatrician Dr. Barton Schmidt recommends this approach for children over 30 months who have already used the potty with parental assistance (Schmidt 2004). If kids are slow to graduate from parent-led practice-runs to full, toileting independence, the “bare bottom" method might help them make that last breakthrough.
According to Schmidt, parents interested in this approach should reserve at least one six-hour block of time (or a weekend) for training. Some children might require several consecutive days. Remove all distractions, strip your child below the waist and let her play. Offer her lots of fluids to create many opportunities to pee. Keep her within easy access of a potty chair at all times. This is easiest if you confine your child to a room (or even better, a backyard if it’s warm outside). Stay with your child, but do not ask her to sit on the potty. Be cheerful, and let her work things out for herself.
If you are wondering what happens when your child has accidents, the answer is that you get a mess. For this reason, you’ll want to stage your training session in a place that is easy to clean. Clean accidents without giving any lectures or lessons. Be upbeat and affectionate.
Although there are no scientific studies evaluating this approach, Dr. Schmidt reports a high success rate in his own practice (Schmidt 2004a). And similar claims have been made by psychologist John Rosemond, Ph.D.
References: Toilet training techniques
Azrin NH and Foxx RM. 1974. Toilet training in less than a day. New York: Pocket Books.
Butler JF. 1976. The toilet training success of parents after
reading toilet training in less than a day. Behav Ther 7(2):185-91.
Candelora K. 1977. An evaluation of two approaches to toilet training normal children. Diss Abstr Int. 38(5-B).
Foxx RM and Azrin NH. 1973. Dry pants: a rapid method of toilet training children. Behav Res Ther 11(4):435-42.
Matson JL and Ollendick TH. 1977. Issues in toilet training normal children. Behav Ther 8(4):549-53.
Schmidt BA. 2004. Toilet training: Getting it right the first time. Contemporary Pediatrics, 21: 105-119.
Klassen TP, Kiddoo D, Lang ME, Friesan C, Russell K, Spooner C,
and Vandermeer B. 2006. The effectiveness of different methods of toilet
training for bladder and bowel control. Evidence Report/Technology
Assessment No. 147. (Prepared by the University of Alberta
Evidence-based Practice Center, under contract number 290-02-0023). AHRQ
Publication No. 07-E003. Rockville, MD: Agency for Healthcare Research