Case report: an attendant-administered contingency management programme for the treatment of a toileting phobia

A fifteen-year-old mentally retarded child, institutionalised for eleven years, displayed an intense fear of urinating in a toilet. As a result, he wet his pants at a frequent rate. In an attempt to eliminate this fear a variety of response-contingent consequences were programed (token reinforcement, social reinforcement, time-out). The effects of introducing structured contingencies resulted in a steady reduction in the frequency of pants wettings. During a follow-up phase of evaluation, when programmed contingencies were discontinued, the problem behaviour had been completely eliminated. At that time the child was initiating his own bathroom visits and toileting himself in an appropriate manner.