Behaviour therapy and encopresis: The complexities involved in treatment

Operant Conditioning of Schizophrenic Children

Though there is little agreement concerning the diagnosis, incidence or etiology of childhood schizophrenia, until recently most authors agree there is no effective treatment. Operant conditioning is reported to succeed where other therapies have failed. Twenty children diagnosed according to Creak's criteria in two groups matched for age, sex, duration of stay, Vineland score and amount of speech, were treated by either interpretive play therapy or operant conditioning. Emotional relatedness and self-identity, then imitation of ‘behaviour and speech were conditioned with the positive reinforcements of candy. Tested before, during and after fifty 45-minute sessions, those in the operant-conditioning group had gained more speech and improved more on Vineland score. The relative efficacy of operant conditioning may be related to the greater ease with which the staff learned this technique and the need of these children for predictable routines. The experiment will continue with a crossover complex.

Operant conditioning of human anal sphincter pressure

Anal sphincter pressure in a 13-yr-old encopretic boy was modified by reinforcing increases in pressure exerted on a fluid-filled balloon inserted into the rectum. It was found that pressure changes were a function of the reinforcement schedule and that baseline levels (resting pressure) during extinction conditions tended to increase throughout the experiment.

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.

The treatment of intractable encopresis: a team intervention approach

Childhood encopresis is discussed in terms of problems of definition, approaches to management in relation to symptoms and underlying mechanisms, and efficacy of treatment. Case histories of six intractable clinic cases are examined and an intensive team intervention programme described. Difficulties in carrying through a consistent plan are outlined: the key worker providing an essential motivational role towards participant staff, parents and child.

Chronic encopresis: a system based psychodynamic approach

A successful method used in treating a series of five cases of chronic encopresis is reported. The method is a system based approach, taking into account the typically underlying hostile mother-child psychodynamics accompanying encopresis.

Treatment of encopresis by overcorrection

Positive practice, cleanliness training, and periodic inspections for dry pants with contingent positive reinforcement were successfully used to eliminate the encopresis of 3 children. With these children no other difficulties were reported or observed. Overcorrection procedures have been used to treat encopretic children who are either retarded or autistic. Past case reports of behavioral interventions with encopretic children were reviewed and compared with overcorrection which seems an effective, valid, and enduring method for the treatment of encopresis. In these case reports, the parents were utilized as mediators in the natural environment and these changes in toileting behavior were maintained for over a 6-mo. follow-up.

Reinforcement procedures in the control of encopresis: a case study

A student and his problems were pin-pointed, recorded, and changed. The first 3 wk. were used to establish a base rate. S defecated in class, once every few days. After he was programmed with reinforcers (charting and coupons toward book purchases), he may have had one accident, only, for the remainder of the school year (8 wk.). Follow-up through the seventh month of the next school year (the time of this writing) indicates one accident only. During this 7-mo. period, he was not programmed with book coupons or any other specific reinforcer. He had internalized a previous external model of control.