A Gamified Video Modeling Application for Toilet Training in Children with Autism Spectrum Disorder: Pilot Feasibility and Effectiveness Study (Preprint)

BACKGROUND Toilet training is a major challenge for children with autism spectrum disorder (ASD). While mobile health (mHealth) offers accessible support, few apps specifically address the complex chaining required for independent toileting routines. OBJECTIVE This pilot study evaluated the feasibility and preliminary effectiveness of a caregiver-mediated mobile application using stepwise animated video modeling and gamification for toilet training in young children with ASD. METHODS A multiple-baseline design across participants was employed with ten enrolled children (aged 3–6 years). The tablet-based intervention guided a 16-step toileting routine using animation and token reinforcement. Primary outcomes were caregiver-recorded in-toilet elimination success (%) and routine completion (%). Secondary outcomes included standardized adaptive behavior scores (KSIBR) and social validity. RESULTS Four children completed the study, while six discontinued, highlighting feasibility constraints related to child engagement. Among completers, in-toilet elimination success improved substantially from baseline, reaching 100% for all participants at the 3-month follow-up. Notably, one participant achieved mastery from a stable 0% baseline. Routine completion also increased across all participants, indicating improved independence. Caregivers reported high treatment fidelity and favorable social validity. CONCLUSIONS The application was an effective tool for families who maintained engagement, leading to mastery of toileting skills. However, the high attrition rate suggests that successful home implementation requires specific child prerequisites and parental resources. Future research should focus on defining inclusion criteria to identify optimal responders for digital toileting interventions.