Objectives: 

Although the challenges of toilet training for children and adolescents with Down syndrome (DS) are well-known, details such as specific associations with comorbidities and related exacerbating factors are lacking. This study aims to characterize the nature of toilet training in a cohort of children and adolescents with DS and evaluate characteristics and comorbid conditions that may contribute to or prolong toilet training success in those with DS.

Method: 

This was a retrospective, cross-sectional study investigating toilet training in children and adolescents with DS. A survey was completed by 137 patients' parents or guardians as part of their care experience in the clinic.

Results: 

Although toilet training on average began at age 3.40 years (SD = 1.47), children and adolescents with DS typically began telling caregivers they needed to use the toilet at 4.80 years (SD = 2.11), no longer used diapers during the day at 5.03 years (SD = 1.98) and night at 5.88 years (SD = 2.48), and were described by their caregivers as being fully toilet trained at 6.60 years (n = 28; SD = 2.43; range = 3.00–14.00 years). There was a linear trend in the age groups between 2 to 4 years (n = 37), 5 to 7 years (n = 42), 8 to 12 years (n = 39), and 13 to 17 years (n = 19) and the proportion of children and adolescents fully toilet trained (2 to 4 years = 0.040, 5 to 7 years = 0.211, 8 to 12 years = 0.278, and 13 to 17 years = 0.529). Typical readiness signs that children and adolescents with DS display and those most predictive of toileting success are reported. Placing the child on a schedule was the most successful (45.2%) training method identified by parents, with 55.8% of the families trying this approach. Children and adolescents aged 8 to 12 years with behavioral challenges were more likely (75.0%) to have daytime accidents compared with those without (25.9%), p = 0.006.

Conclusion: 

Children and adolescents with DS in this sample started toilet training at 3.4 years and completed toilet training at 6.6 years. Even after completing toilet training, many children and adolescents continue to require support from their caregivers with some aspects of toilet training. Skill loss associated with various life events, behavioral challenges, medical diagnoses, and inconsistencies in toileting expectations across settings are factors caregivers believe contribute to delayed toilet training. Caregivers found that a consistent toileting schedule, using reinforcers, and providing prompting to use the toilet were the most successful methods.

中文翻译：

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唐氏综合症儿童和青少年的如厕训练

目标： 

尽管唐氏综合症 (DS) 儿童和青少年如厕训练的挑战众所周知，但缺乏与合并症和相关恶化因素的具体关联等细节。本研究旨在描述一组 DS 儿童和青少年如厕训练的性质，并评估可能有助于或延长 DS 患者如厕训练成功的特征和合并症。

方法： 

这是一项回顾性横断面研究，调查 DS 患儿和青少年的如厕训练。一项调查由 137 名患者的父母或监护人完成，作为他们在诊所护理经验的一部分。

结果： 

虽然平均从 3.40 岁开始如厕训练（SD = 1.47），但患有 DS 的儿童和青少年通常在 4.80 岁（SD = 2.11）开始告诉照顾者他们需要上厕所，在 5.03 岁时不再使用白天尿布(SD = 1.98) 和 5.88 岁的夜晚 (SD = 2.48)，并被他们的照顾者描述为在 6.60 岁时接受过全面的如厕训练 (n = 28; SD = 2.43; 范围 = 3.00-14.00 岁)。在 2 至 4 岁 (n = 37)、5 至 7 岁 (n = 42)、8 至 12 岁 (n = 39) 和 13 至 17 岁 (n = 19) 的年龄组中存在线性趋势以及接受过如厕训练的儿童和青少年的比例（2 至 4 岁 = 0.040、5 至 7 岁 = 0.211、8 至 12 岁 = 0.278 和 13 至 17 岁 = 0.529）。据报道，患有 DS 的儿童和青少年表现出的典型准备迹象以及最能预测如厕成功的迹象。让孩子按计划安排是父母确定的最成功的（45.2%）培训方法，55.8% 的家庭尝试了这种方法。与没有行为障碍的儿童和青少年（25.9%）相比，有行为挑战的 8 至 12 岁儿童和青少年更可能（75.0%）发生白天事故，p = 0.006。

结论： 

本样本中患有 DS 的儿童和青少年在 3.4 岁时开始如厕训练，并在 6.6 岁时完成如厕训练。即使在完成如厕训练之后，许多儿童和青少年仍然需要​​他们的看护者在如厕训练的某些方面提供支持。与各种生活事件、行为挑战、医学诊断相关的技能丧失以及不同环境中如厕期望的不一致是护理人员认为导致如厕训练延迟的因素。护理人员发现，一致的如厕时间表、使用强化物和提示使用厕所是最成功的方法。