Journal of Pediatric Psychology, Vol. 25, No. 4, 2000, pp. 225-254
© 2000 Society of Pediatric Psychology
Empirically Supported Treatments in Pediatric Psychology: Constipation and Encopresis
1 Tulane University, 2 Mayo Clinic
All correspondence should be sent to Melanie McGrath, Department of Psychology, Tulane University, 2007 Percival Stern Hall, New Orleans, Louisiana 70118-5698. E-mail: mmcgrath{at}mailhost.tcs.tulane.edu
Objective: To review the empirical research examining behavioral and medical treatments for constipation and fecal incontinence.
Method: Sixty-five articles investigating intervention efficacy were identified and reviewed. Twenty-three of the studies were excluded because they were case studies or were less well-controlled single-case designs. The intervention protocol for each study was identified and coded, with studies employing the same interventions matched and evaluated according to the Chambless criteria.
Results: From the literature base to date, no well-established interventions have emerged. However, four probably efficacious treatments and three promising interventions were identified. Two different medical interventions plus positive reinforcement fit the criteria for the probably efficacious category (one with fiber recommendation and one without). Three biofeedback plus medical interventions fit efficacy category criteria: one probably efficacious for constipation with abnormal defecation dynamics (full medical intervention plus biofeedback for paradoxical contraction), and two fit the promising intervention criteria for constipation and abnormal defecation dynamics (full medical intervention plus biofeedback for EAS strengthening, correction of paradoxical contraction and home practice; and biofeedback focused on correction of paradoxical contraction, medical intervention without fiber recommendation, and positive reinforcement). Two extensive behavioral interventions plus medical intervention also met efficacy criteria for constipation plus incontinence (medical intervention without laxative maintenance plus positive reinforcement, dietary education, goal setting, and skills building presented in a small-group format fits criteria for a promising intervention; and positive reinforcement and skills building focused on relaxation of the EAS during defecation, but without biofeedback, plus medical intervention meets the probably efficacious criteria).
Conclusions: A discussion of the current weaknesses in this research area follows. Specific recommendations for future research are made including greater clarity in treatment protocol and sample descriptions, reporting cure rates rather than success rates, utilization of adherence checks, and investigation of potential differential outcomes for subgroups of children with constipation and incontinence.
Key words: constipation; encopresis; fecal incontinence; intervention; biofeedback; efficacy.
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  M. van Dijk, M. E. J. Bongers, G.-J. de Vries, M. A. Grootenhuis, B. F. Last, and M. A. Benninga Behavioral Therapy for Childhood Constipation: A Randomized, Controlled Trial Pediatrics, May 1, 2008; 121(5): e1334 - e1341. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 H. Reid and R. J. Bahar Treatment of Encopresis and Chronic Constipation in Young Children: Clinical Results from Interactive Parent-Child Guidance Clinical Pediatrics, March 1, 2006; 45(2): 157 - 164. [Abstract] [PDF]
|
|
|
|
 |
|
 S. W. Powers, J. S. Jones, and B. A. Jones Behavioral and Cognitive-Behavioral Interventions with Pediatric Populations Clinical Child Psychology and Psychiatry, January 1, 2005; 10(1): 65 - 77. [Abstract] [PDF]
|
|
|
|
 |
|
 D. J. Cox, L. M. Ritterband, W. Quillian, B. Kovatchev, J. Morris, J. Sutphen, and S. Borowitz Assessment of Behavioral Mechanisms Maintaining Encopresis: Virginia Encopresis-Constipation Apperception Test J. Pediatr. Psychol., September 1, 2003; 28(6): 375 - 382. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Spirito, R. T. Brown, E. D'Angelo, A. Delamater, J. Rodrigue, and L. Siegel Society of Pediatric Psychology Task Force Report: Recommendations for the Training of Pediatric Psychologists J. Pediatr. Psychol., March 1, 2003; 28(2): 85 - 98. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. Drotar Enhancing Reviews of Psychological Treatments With Pediatric Populations: Thoughts on Next Steps J. Pediatr. Psychol., March 1, 2002; 27(2): 167 - 176. [Abstract] [Full Text] [PDF]
|
|