Warzak William J, Forcino Stacy S, Sanberg Sela Ann, Gross Amy C
Department of Psychology, Munroe Meyer Institute, University of Nebraska Medical Center, Omaha, NE (S. S. Forcino is now at Department of Psychology, California State University, San Bernardino, San Bernardino, CA. S. A. Sanberg is now at Department of Psychology, Western Michigan University, Kalamazoo, MI. A. C. Gross is now at Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN).
J Dev Behav Pediatr. 2016 Jan;37(1):83-7. doi: 10.1097/DBP.0000000000000232.
To (1) identify and summarize procedures of Foxx and Azrin's classic toilet training protocol that continue to be used in training typically developing children and (2) adapt recent findings with the original Foxx and Azrin procedures to inform practical suggestions for the rapid toilet training of typically developing children in the primary care setting.
Literature searches of PsychINFO and MEDLINE databases used the search terms "(toilet* OR potty* AND train*)." Selection criteria were only peer-reviewed experimental articles that evaluated intensive toilet training with typically developing children. Exclusion criteria were (1) nonpeer reviewed research, (2) studies addressing encopresis and/or enuresis, (3) studies excluding typically developing children, and (4) studies evaluating toilet training during infancy.
In addition to the study of Foxx and Azrin, only 4 publications met the above criteria. Toilet training procedures from each article were reviewed to determine which toilet training methods were similar to components described by Foxx and Azrin. Common training elements include increasing the frequency of learning opportunities through fluid loading and having differential consequences for being dry versus being wet and for voiding in the toilet versus elsewhere.
There is little research on intensive toilet training of typically developing children. Practice sits and positive reinforcement for voids in the toilet are commonplace, consistent with the Foxx and Azrin protocol, whereas positive practice as a corrective procedure for wetting accidents often is omitted. Fluid loading and differential consequences for being dry versus being wet and for voiding in the toilet also are suggested procedures, consistent with the Foxx and Azrin protocol.
（1）识别并总结福克斯和阿兹林经典如厕训练方案中仍用于训练发育正常儿童的程序；（2）结合福克斯和阿兹林原始程序的最新研究结果，为在初级保健环境中对发育正常儿童进行快速如厕训练提供实用建议。
在PsychINFO和MEDLINE数据库中进行文献检索，检索词为“（toilet* OR potty* AND train*）”。入选标准仅为评估对发育正常儿童进行强化如厕训练的同行评审实验性文章。排除标准为：（1）非同行评审研究；（2）涉及大便失禁和/或遗尿症的研究；（3）排除发育正常儿童的研究；（4）评估婴儿期如厕训练的研究。
除了福克斯和阿兹林的研究外，只有4篇出版物符合上述标准。对每篇文章中的如厕训练程序进行了审查，以确定哪些如厕训练方法与福克斯和阿兹林描述的组件相似。常见的训练要素包括通过液体摄入增加学习机会的频率，以及对干爽与潮湿、在厕所排尿与在其他地方排尿有不同的后果。
关于对发育正常儿童进行强化如厕训练的研究很少。让孩子坐在便器上并对在厕所排尿给予积极强化是常见做法，这与福克斯和阿兹林的方案一致，而将积极练习作为对尿床意外的纠正程序往往被省略。液体摄入以及对干爽与潮湿、在厕所排尿有不同后果也是建议的程序，与福克斯和阿兹林的方案一致。
