Case histories and shorter communications: a simple behavioral treatment program for psychogenic encopresis

Behavioral management of toilet training, enuresis, and encopresis

Toileting problems are a matter of great concern to parents and are a frequent source of family discord, but proper handling of toilet training as well as enuresis and encopresis can ameliorate any untoward effects of these problems. Both the pediatrician and the pediatric psychologist can play a major role in this area.

Encopresis and constipation in children

Chronic retentive constipation in children is common, often undertreated, and frequently resistant to standard treatment. A new understanding of abnormal defecation dynamics has evolved to complement the established medical behavior model of this condition. The primary care pediatrician is in an excellent position to facilitate prevention through counseling on normal bowel habits and early intervention. A comprehensive medical behavior intervention program can be supervised effectively by the pediatrician providing benefit to most patients. Those who are compliant with treatment and are resistant to intervention may benefit by extensive evaluation of anorectal dynamics and use of such teaching as biofeedback training.

The "bathroom game": a systematic program for the elimination of encopretic behavior

The present investigation utilized a unique, variable ratio schedule of reinforcement (the "bathroom game") to treat a 10-year-old encopretic male. Dependent measures included confirmed incidents of (a) soiling and (b) appropriate bowel movements monitored across an ABAB design (Baseline 1, "Bathroom Game 1", Baseline 2, "Bathroom Game 2") with one-year follow-up. During "bathroom game" conditions, contingent monetary rewards were provided for non-instances of soiling and appropriate bowel movements. Such rewards were progressively and systematically leaned-out over the course of treatment on a pre-determined variable ratio schedule. Results indicated a clear demonstration of functional control and clinically significant treatment effects during both experimental periods. These findings are discussed with regard to the positive features of the "bathroom game" procedure and recommendations are made for future investigations in the area.

Behavioural social work with encopretic children, their families and the school

Social work intervention and the use of behaviour modification techniques is described in five cases of childhood encopresis, all boys. In two cases an operant model was adopted and the parents were asked to reinforce with praise and stars approximation to the goal (trying) as well as success (defaecation into the lavatory). The P.S.W. rewarded the children intermittently with praise and small gifts and supported and praised the mother for the efforts they were making. In the third case contingencies surrounding elimination were altered in order to bring about desensitization following an injury the child had suffered while sitting on the seat of the school lavatory. This had resulted in fearfulness over going to the toilet at school culminating in alternate soiling and constipation. In the remaining two cases self-monitoring was central to the treatment and training. The work was done within the context of a conventional casework relationship with the whole family which was warm and supportive in nature and directed towards problem solving in more than one area. Other members of the Child Guidance Team were involved with some of the children for the purpose of assessment, but the programmes were devised and carried out by the P.S.W. The author expresses the view that 'treatment through training' has shown better and quicker results than 'treating the underlying causes--not the symptom'. Several behavioural programmes currently in use are described and reasons given for the author's preference for the procedure adopted here.