Background: Toilet skill problems have been reported among children with sensory processing disorders (SPD) in recent literatures. Pollock concluded that children with dysfunctional elimination syndrome (53%) had SPD than was reported for the general population. Occupational therapists from India experience similar observations in their clinical practice. However, there is limited evidence within the Indian context. Objectives: The objectives of the study are to find the prevalence of problems in toilet skills in children with SPD and the effectiveness of sensory integration therapy (SIT) for the improvement of toilet skills in children with SPD. And also to compare the effectiveness of SIT with behavior modification for developing age-appropriate toileting habits in children with SPD. Study Design: A cross-sectional survey and quasi-experimental pre-posttest design were adopted for the study. Methods: The study consisted of 2 phases. In Phase 1, 96 children with SPD were screened to find out the prevalence of toilet skill problems among them. In Phase 2, the study effectiveness of SIT on toilet skill development was investigated on 22 children. The baseline and posttest measurement were done using sensory profile (SP), Canadian Occupational Performance Measure and modified diet schedule. The control group underwent behavior modification therapy, and experimental group, in addition, underwent SIT for 4 months. Both groups also underwent conventional occupational therapy. Results: This study found out among 96 SPD children, 68.75% had toilet skill problems. There was the difference in sections, factors, and quadrants in SP for children with and without toilet skill problems. In Phase 2, the result shows a significant difference (P