A Multidisciplinary Intervention for Encopresis in Children With ASD

Posted August 22, 2023

Nathan Call, Ph.D., BCBA-D., Emory University

Nathan Call, Ph.D., BCBA-D., Emory University
Dr. Nathan Call
(Photo Provided)

Incontinence is a common concern among individuals with autism spectrum disorder (ASD). Existing treatments have generally utilized lengthy and invasive procedures and/or lacked methodological rigor. Furthermore, no treatment approach has incorporated medical approaches to address constipation, which is a significant contributor to encopresis in this population.

To address this problem, with support from a fiscal year 2016 Autism Research Program Clinical Trial Award, Dr. Nathan Call developed a 2-week multidisciplinary intervention for encopresis (MIE) that combined medical and behavioral approaches. This intervention involved assessment by a gastroenterologist and outpatient behavioral treatments that included structured sitting on a toilet and use of a suppository, if needed, to promote independent bowel movements. The overall goal of this work was to demonstrate the efficacy of MIE by improving rates of continence (defined as no more than one incontinent bowel movement and at least six continent bowel movements over 14 days) and toileting independence (defined as continent bowel movements without the use of medication for 80% of bowel movements over 14 days).

Participants were randomly assigned to receive MIE or treatment as usual (TAU), which consisted of current best practices (i.e., medical treatment of constipation, and parent education and consultation on toilet training with a doctoral-level behavioral clinician). During the course of this study, 129 individuals consented to participation and were formally enrolled in the study. The Clinical Global Impressions-Improvement (CGI-I) scale was used to assess improvement and response to the intervention; participants who received a rating from a clinician blind to group assignment of “much improved” or “very much improved” were considered responders. Overall, this measure showed significant improvement in subjects receiving MIE for 1 week (38.5%) and 2 weeks (44.7%) compared to TAU (15.9%).

Given that 59% of children with ASD have toileting deficits (Tsai et al., 1981), the results of this study will impact a large number of individuals in the ASD population. Results from this project may have an impact on policies related to coverage for treatment of encopresis in children and adolescents with ASD and encopresis by payors and in practices related to the same. By promoting treatment methods for encopresis, children with ASD and their families will benefit through decreased parental stress, increased inclusion in the community, and removal of a potential barriers to developing social and other adaptive skills.

Public and Technical Abstracts: A Multidisciplinary Intervention for Encopresis in Children With ASD

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Last updated Tuesday, August 22, 2023