Background: Incontinence is a common concern among individuals with autism spectrum disorder (ASD). Detrimental effects associated with incontinence include significant stress for caregivers, barriers to inclusion, and social stigma. Unfortunately, there is a notable lack of empirically supported treatments for encopresis with 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. In response to the absence of treatments for this problem, we designed a 2-week multidisciplinary intervention for encopresis (MIE) that combines medical and behavioral approaches. In MIE, children are screened by a gastroenterologist and assessed and treated for constipation. Patients also receive outpatient behavioral treatments that include structured sitting on a toilet to promote independent bowel movements. If one does not occur, the behavioral clinician administers a suppository and prompts the child to remain on the toilet. In doing so, continent bowel movements are predictably evoked, allowing for reinforcement. Eventually, the suppositories are gradually faded out to promote independence.Objective/Hypothesis: We plan to evaluate MIE and hypothesize that MIE is superior to treatment as usual (TAU). We also hypothesize that 2-week MIE is superior to a lower dose of treatment (1 week). Support for this hypothesis comes from clinical and pilot data. When implemented clinically, 93% of MIE patients achieve continence. We have also evaluated MIE in a small randomized clinical trial (n=20; randomized to MIE or waitlist control): 80% of participants in the treatment group (and none in the control) achieved continence and 77.8% achieved independence. This initial clinical trial also demonstrated feasibility: recruitment was obtainable (20 participants recruited in 6 months), dropout was low (5%), and treatment was acceptable to caregivers. This study will be the first large-scale clinical trial of a treatment of encopresis in individuals with ASD. In doing so, we will be establishing the foundation for future research, including effectiveness studies of MIE.Specific Aims:(1) Demonstrate the efficacy of MIE: Compared to matched controls who receive current best practices, children with ASD and encopresis who complete clinic-based MIE for 10 days will demonstrate significantly greater improvements in continence, independence, and collateral consequences (e.g., parental stress, stigma) immediately following treatment and at follow-up.(2) Examine the relationship between treatment duration and outcomes: Results from 1 week of MIE will be superior to TAU but inferior to 2-week MIE on the outcomes above.(3) Identify moderators that predict success of MIE: Determine whether variables related to the child (such as whether the child is constipated and degree of developmental delay) relate to the success of treatment.Study Design: We will recruit 150 individuals diagnosed with ASD age 5-12 with the presenting concern of encopresis. We will randomly assign participants to 2-week MIE (n=60), 1-week MIE (n=60), or TAU. We will collect outcome measures at baseline, endpoint (Week 8), and follow-up (Week 28). Measures will include percentage of children who achieve continence, independence (continence without the need for suppositories), caregiver stress, and overall improvement.
Interagency Autism Coordinating Committee (IACC)
Autism Research Database (AFD)
