Skip to main content

Advertisement

SpringerLink
Log in

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

  • Original Paper
  • Published:
Journal of Autism and Developmental Disorders Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  • 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.

    Article  Google Scholar 

  • Azrin, N. H., & Foxx, R. M. (1971). A rapid method of toilet training the institutionalized retarded. Journal of Applied Behavior Analysis,4, 89–99.

    Article  Google Scholar 

  • 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.

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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 

  • 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.

    Chapter  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Chapter  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • Levine, M. D. (1982). Encopresis: Its potentiation, evaluation, and alleviation. Pediatric Clinics of North America,29, 315–330.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • McElhanon, B. O., McCracken, C., Karpen, S., & Sharp, W. G. (2014). Gastrointestinal symptoms in autism spectrum disorders: A meta-analysis. Pediatrics,133, 872–883.

    Article  Google Scholar 

  • 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 

  • Niemczyk, J., Wagner, C., & von Gontard, A. (2018). Incontinence in autism spectrum disorder: A systematic review. European Child and Adolescent Psychiatry,27, 1523–1537.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • Rodger, S., Braithwaite, M., & Keen, D. (2004). Early intervention for children with autism: Parental priorities. Australisian Journal of Early Childhood,29, 34–41.

    Article  Google Scholar 

  • Rutter, M., Bailey, A., & Lord, C. (2003). Social Communication Questionnaire. Los Angeles, CA: Western Psychological Services.

    Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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 

  • 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.

    Article  Google Scholar 

  • 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 

  • 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.

    PubMed  Google Scholar 

  • 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.

    Article  Google Scholar 

Download references

Funding

Funding was provided by Organization for Autism Research.

Author information

Authors and Affiliations

  1. Division of Autism & Related Disabilities, Emory University School of Medicine, Atlanta, USA

    Joanna Lomas Mevers, Nathan A. Call, Kristina R. Gerencser, Mindy Scheithauer, Colin Muething, Courtney McCracken, Lawrence Scahill & Barbara O. McElhanon

  2. Division of Autism & Related Disabilities, Marcus Autism Center, 1920 Briarcliff Rd., Atlanta, GA, 30329, USA

    Joanna Lomas Mevers, Nathan A. Call, Kristina R. Gerencser, Mindy Scheithauer, Colin Muething & Shannon Hewett

  3. Division of Autism & Related Disabilities, Children’s Healthcare of Atlanta, Atlanta, USA

    Joanna Lomas Mevers, Nathan A. Call, Kristina R. Gerencser, Mindy Scheithauer, Colin Muething & Barbara O. McElhanon

  4. Children’s Hospital New Orleans, New Orleans, USA

    Sarah J. Miller

Authors
  1. Joanna Lomas Mevers
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Nathan A. Call
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Kristina R. Gerencser
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Mindy Scheithauer
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Sarah J. Miller
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Colin Muething
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Shannon Hewett
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Courtney McCracken
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Lawrence Scahill
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Barbara O. McElhanon
    View author publications

    You can also search for this author in PubMed Google Scholar

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.

Corresponding author

Correspondence to Joanna Lomas Mevers.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Lomas Mevers, J., Call, N.A., Gerencser, K.R. et al. A Pilot Randomized Clinical Trial of a Multidisciplinary Intervention for Encopresis in Children with Autism Spectrum Disorder. J Autism Dev Disord 50, 757–765 (2020). https://doi.org/10.1007/s10803-019-04305-5

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10803-019-04305-5

Keywords

Search

Navigation