Advertisement

A Pilot Randomized Clinical Trial of a Multidisciplinary Intervention for Encopresis in Children with Autism Spectrum Disorder

  • Joanna Lomas MeversEmail author
  • Nathan A. Call
  • Kristina R. Gerencser
  • Mindy Scheithauer
  • Sarah J. Miller
  • Colin Muething
  • Shannon Hewett
  • Courtney McCracken
  • Lawrence Scahill
  • Barbara O. McElhanon
Original Paper

Abstract

Children with autism spectrum disorder (ASD) are often delayed in achieving bowel continence, resulting in negative outcomes. In this pilot trial, 20 children with ASD and encopresis were randomly assigned to multidisciplinary intervention for encopresis (MIE; n = 10) or a waitlist control group (n = 10). The MIE group was treated for constipation and received a 10-day behavioral intervention that utilized suppositories to produce predictable bowel movements that were reinforced. Caregivers were trained to implement the intervention. Results support the feasibility of clinical trials of MIE, with high enrolment, competition, attendance, and caregiver acceptability. Preliminary outcomes were positive, with six of 10 in the MIE group achieving continence by the end of treatment compared to 0 in the control group (p = 0.005).

Registered at clinicaltrials.gov (https://clinicaltrials.gov); ID: NCT02383732.

Keywords

Encopresis Multidisciplinary treatment Pediatric gastroenterology 

Notes

Author Contributions

All authors contributed to the study conception, design, data collection and/or study implementation. Material preparation, data collection and analysis were performed by JLM, NAC, KRG, MS, SJM, CM, SH, CM, LS, and BOM. JLM wrote the first draft of the manuscript and all authors contributed on previous versions of the manuscript. All authors read and approved the final manuscript with the expectation of SH who had left the organization prior to completion of the final manuscript.

Funding

Funding was provided by Organization for Autism Research.

References

  1. Axelrod, M. I., Tornehl, M., & Fontanini-Axelrod, A. (2016). Co-occurring autism and intellectual disability: A treatment for encopresis using a behavioral intervention plus laxative across settings. Clinical Practice in Pediatric Psychology,4, 1–10.CrossRefGoogle Scholar
  2. Azrin, N. H., & Foxx, R. M. (1971). A rapid method of toilet training the institutionalized retarded. Journal of Applied Behavior Analysis,4, 89–99.CrossRefGoogle Scholar
  3. Bearss, K., Johnson, C., Smith, T., Lecavalier, L., Swiezy, N., Aman, M., … Scahill., L. (2015). Effects of parent training vs parent education on behavioral problems in children with autism spectrum disorder: A randomized clinical trial. Journal of the American Medical Association, 313, 1524–1533.Google Scholar
  4. Blum, N. J., Taubman, B., & Nemeth, N. (2003). Relationship between age at initiation of toilet training and duration of training: A prospective study. Pediatrics,111, 810–814.CrossRefGoogle Scholar
  5. Call, N. A., Lomas Mevers, J., McElhanon, B. O., & Scheithauer, M. C. (2017). A multidisciplinary treatment for encopresis in children with developmental disabilities. Journal of Applied Behavior Analysis,50, 332–344.CrossRefGoogle Scholar
  6. Christophersen, E. R., & Friman, P. C. (2004). Elimination disorders. In R. T. Brown (Ed.), Handbook of pediatric psychology in school settings (pp. 467–487). Mahwah, NJ: Lawrence Erlbaum Associates.Google Scholar
  7. DeLeon, I. G., & Iwata, B. A. (1996). Evaluation of a multiple stimulus presentation format for assessing reinforcer preferences. Journal of Applied Behavior Analysis,29, 519–533.CrossRefGoogle Scholar
  8. Dos Santos, J., Lopes, R. I., & Koyle, M. A. (2017). Bladder and bowel dysfunction in children: An update on the diagnosis and treatment of a common, but underdiagnosed pediatric problem. Canadian Urological Association Journal,11, S64–S72.CrossRefGoogle Scholar
  9. Fishman, L., Rappaport, L., Cousineau, D., & Nurko, S. (2002). Early constipation and toilet training in children with encopresis. Journal of Pediatric Gastroenterology and Nutrition,34, 385–388.CrossRefGoogle Scholar
  10. Friman, P. C. (2003). A biobehavioral bowel and toilet training treatment for functional encopresis. In W. Odonohue, S. Hayes, & J. Fisher (Eds.), General principles and empirically supported techniques of cognitive behavior therapy (pp. 51–58). Hoboken, NJ: Wiley.Google Scholar
  11. Friman, P. C. (2008). Evidence-based therapies for enuresis and encopresis. In R. G. Steele, T. D. Elkin, & M. Roberts (Eds.), Handbook of evidence-based therapies for children and adolescents (pp. 311–333). New York: Springer.CrossRefGoogle Scholar
  12. Friman, P. C., Hofstadter, K. L., & Jones, K. M. (2006). A biobehavioral approach to the treatment of functional encopresis in children. Journal of Early and Intensive Behavior Intervention,3, 263.CrossRefGoogle Scholar
  13. Friman, P. C., & Jones, K. M. (1998). Elimination disorders in children. In S. T. Watson & F. M. Greshman (Eds.), Handbook of child behavior therapy (pp. 239–260). Boston, MA: Springer.CrossRefGoogle Scholar
  14. Furuta, G. T., Williams, K., Kooros, K., Kaul, A., Panzer, R., Coury, D. L., et al. (2012). Management of constipation in children and adolescents with autism spectrum disorders. Pediatrics,130, S98–S105.CrossRefGoogle Scholar
  15. Heron, J., Joinson, C., Croudace, T., & von Gontard, A. (2008). Trajectories of daytime wetting and soiling in a United Kingdom 4 to 9-year-old population birth cohort study. The Journal of Urology,179, 1970–1975.CrossRefGoogle Scholar
  16. Huntley, E., & Smith, L. (1999). Long-term follow-up of behavioural treatment for primary encopresis in people with intellectual disability in the community. Journal of Intellectual Disability Research,43, 484–488.CrossRefGoogle Scholar
  17. King, B. H., Hollander, E., Sikich, L., McCracken, J. T., Scahill. L., Bregman, J. D., … & Ritz, L. (2009). Lack of efficacy of citalopram in children with autism spectrum disorders and high levels of repetitive behavior: citalopram ineffective in children with autism. Archives of General Psychiatry, 66, 583–590.Google Scholar
  18. Lancioni, G. E., O’Reilly, M. F., & Basili, G. (2001). Treating encopresis in people with intellectual disabilities: A literature review. Journal of Applied Research in Intellectual Disabilities,14, 47–63.CrossRefGoogle Scholar
  19. LeBlanc, L. A., Carr, J. E., Crossett, S. E., Bennett, C. M., & Detweiler, D. D. (2005). Intensive outpatient behavioral treatment of primary urinary incontinence of children with autism. Focus on Autism and Other Developmental Disabilities,20(2), 98–105.CrossRefGoogle Scholar
  20. Leon, A. C., Davis, L. L., & Kraemer, H. C. (2011). The role and interpretation of pilot studies in clinical research. Journal of Psychiatric Research,45, 626–629.CrossRefGoogle Scholar
  21. Levine, M. D. (1982). Encopresis: Its potentiation, evaluation, and alleviation. Pediatric Clinics of North America,29, 315–330.CrossRefGoogle Scholar
  22. Lomas Mevers, J., Muething, C., Call, N. A., Scheithauer, M., & Hewett, S. (2018). A consecutive case series analysis of behavioural intervention for enuresis in children with developmental disabilities. Developmental Neurorehabilitation,21, 336–344.CrossRefGoogle Scholar
  23. Lord, C., Rutter, M., & Le Couteur, A. (1994). Autism diagnostic interview-revised: A revised version of a diagnostic interview for caregivers of individuals with possible pervasive developmental disorders. Journal of Autism Developmental Disorders,24, 659–685.CrossRefGoogle Scholar
  24. Macias, M. M., Roberts, K. M., Saylor, C. F., & Fussell, J. J. (2006). Toileting concerns, parenting stress, and behavior problems of children with special health care needs. Clinical Pediatrics,45, 415–422.CrossRefGoogle Scholar
  25. Matson, J. L., & LoVullo, S. V. (2009). Encopresis, soiling and constipation in children and adults with developmental disability. Research in Developmental Disabilities,30, 799–807.CrossRefGoogle Scholar
  26. McElhanon, B. O., McCracken, C., Karpen, S., & Sharp, W. G. (2014). Gastrointestinal symptoms in autism spectrum disorders: A meta-analysis. Pediatrics,133, 872–883.CrossRefGoogle Scholar
  27. Mruzek, D. W., Handen, B. L., Aponte, C. A., Smith, T., & Foxx, R. M. (2018). Parent training for toileting in autism spectrum disorder. In C. R. Johnson, E. M. Butter, & L. Scahill (Eds.), Parent training for autism spectrum disorder (pp. 203–230). Washington, D.C.: American Psychological Association.Google Scholar
  28. Niemczyk, J., Wagner, C., & von Gontard, A. (2018). Incontinence in autism spectrum disorder: A systematic review. European Child and Adolescent Psychiatry,27, 1523–1537.CrossRefGoogle Scholar
  29. Reimers, T. M., & Wacker, D. P. (1988). Parents’ rating of acceptability of behavioral treatment recommendations made in an outpatient clinic: A preliminary analysis of the influence of treatment effectiveness. Behavioral Disorders,14, 7–15.CrossRefGoogle Scholar
  30. Ritblatt, S. N., Obegi, A. D., Hammons, B. S., Ganger, T. A., & Ganger, B. C. (2003). Parents’ and child care professionals’ toilet training attitudes and practices: A comparative analysis. Journal of Research in Childhood Education,17, 133–146.CrossRefGoogle Scholar
  31. Rodger, S., Braithwaite, M., & Keen, D. (2004). Early intervention for children with autism: Parental priorities. Australisian Journal of Early Childhood,29, 34–41.CrossRefGoogle Scholar
  32. Rutter, M., Bailey, A., & Lord, C. (2003). Social Communication Questionnaire. Los Angeles, CA: Western Psychological Services.Google Scholar
  33. Scahill, L., McCracken, J. T., King, B. H., Rockhill. C., Shah, B., Politte, L., … McDougle, C. J. (2015). Extended-release Guanfacine for hyperactivity in children with autism spectrum disorder. The American Journal of Psychiatry, 172, 1197–1206.CrossRefGoogle Scholar
  34. Schopler, E., Van Bourgondien, M. E., Wellman, G. J., & Love, S. R. (2010). Childhood autism rating scale [Manual] (2nd ed.). Torrance, CA: Western Psychological Services.Google Scholar
  35. Schum, T. R., Kolb, T. M., McAuliffe, T. L., Simms, M. D., Underhill, R. L., & Lewis, M. (2002). Sequential acquisition of toilet-training skills: A descriptive study of gender and age differences in normal children. Pediatrics,109, e48–e48.CrossRefGoogle Scholar
  36. Sparrow, S. S., Cicchetti, D. V., & Balla, D. A. (2005). Vineland adaptive behavior scales: (Vineland II), survey interview form/caregiver rating form. Livonia, MN: Pearson Assessments.Google Scholar
  37. Sujatha, B., Velayutham, D. R., Deivamani, N., & Bavanandam, S. (2015). Normal bowel pattern in children and dietary and other precipitating factors in functional constipation. Journal of Clinical and Diagnostic Research,9, SC12–15.PubMedGoogle Scholar
  38. von Gontard, A. V., Pirrung, M., Niemczyk, J., & Equit, M. (2015). Incontinence in children with autism spectrum disorder. Journal of Pediatric Urology,11, 264.e1–264.e7.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Joanna Lomas Mevers
    • 1
    • 2
    • 3
    Email author
  • Nathan A. Call
    • 1
    • 2
    • 3
  • Kristina R. Gerencser
    • 1
    • 2
    • 3
  • Mindy Scheithauer
    • 1
    • 2
    • 3
  • Sarah J. Miller
    • 4
  • Colin Muething
    • 1
    • 2
    • 3
  • Shannon Hewett
    • 2
  • Courtney McCracken
    • 1
  • Lawrence Scahill
    • 1
  • Barbara O. McElhanon
    • 1
    • 3
  1. 1.Division of Autism & Related DisabilitiesEmory University School of MedicineAtlantaUSA
  2. 2.Division of Autism & Related DisabilitiesMarcus Autism CenterAtlantaUSA
  3. 3.Division of Autism & Related DisabilitiesChildren’s Healthcare of AtlantaAtlantaUSA
  4. 4.Children’s Hospital New OrleansNew OrleansUSA

Personalised recommendations