An Interdisciplinary Approach to the Treatment of Encopresis in Children With Autism Spectrum Disorders

Emory University

Status: Completed

Conditions: Autistic Disorder; Encopresis

Treatments: Drug: Bisacodyl suppository; Drug: Glycerin Suppository; Drug: Senna

Study type: Interventional

Funder types: Other

Identifiers

NCT02383758

IRB00076608

Details and patient eligibility

About

The purpose of this study is to try to treat bowel movement (BM) accidents differently with children with autism spectrum disorder (ASD). The study will use over-the-counter (OTC) medications to evoke predictable bowel movements. This will make it possible for investigators to use certain strategies to reward BMs in the toilet. Independence will be increased by fading out the use of medications. The investigators will also train caregivers to implement the procedures.

Full description

A large percentage of individuals with autism spectrum disorder (ASD) are delayed in achieving continence with bowel movements or never achieve it at all (i.e., they meet criteria for encopresis). This problem has tremendous ramifications for these individuals and their families because encopresis restricts them from integration with peers, limits access to educational opportunities, and carries significant social stigma. Previous interventions for encopresis in this population have either been unsuccessful or required implementation over very long periods.

Enrollment: 22 patients

Sex: All

Ages: 5 to 21 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Age 5-21
• Confirmed diagnosis of autistic spectrum disorder using the Social Communication Questionnaire (SCQ) and the Childhood Autism Rating Scale II (CARSII)
• Clearance from gastroenterologist for use of glycerin suppository, bisacodyl suppository and senna
• Caregiver willing to give consent/assent

Exclusion criteria

• Age under 5 year or over 21 years
• Does not present a diagnosis of autistic spectrum disorder
• Previous intestinal surgeries or concurrent enuresis
• Caregiver unwilling to give consent/assent

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Single Blind

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22 participants in 2 patient groups

Treatment Program

Experimental group

Description:

Pediatric subjects with autistic spectrum disorder will begin treatment immediately. The treatment program will consist of 10 appointments of up to 4 hours each, over a 14 day period, followed by 4 weekly 1-hour follow-up visits. During each appointment, subjects will be guided to sit on the toilet. If the participant has a continent urination they will be provided with praise and remain on the toilet. If a participant has a continent bowel movement they will be provided with enthusiastic praise along with positive reinforcement and they will be allowed to leave the bathroom. A continent bowel movement will end that day's appointment. If necessary, glycerin suppositories, bisacodyl suppositories, and/or senna may be used to aid in the bowl movement.

Treatment:

Drug: Glycerin Suppository

Drug: Senna

Drug: Bisacodyl suppository

Waitlist Control

Active Comparator group

Description:

Pediatric subjects with autistic spectrum disorder will wait for 8 weeks and then be offered treatment at that time.The treatment program will consist of 10 appointments of up to 4 hours each, over a 14 day period, followed by 4 weekly 1-hour follow-up visits. During each appointment, participants will be guided to sit on the toilet. If the participant has a continent urination they will be provided with praise and remain on the toilet. If a participant has a continent bowel movement they will be provided with enthusiastic praise along with positive reinforcement and they will be allowed to leave the bathroom. A continent bowel movement will end that day's appointment. If necessary, glycerin suppositories, bisacodyl suppositories, and/or senna may be used to aid in the bowl movement.

Treatment:

Drug: Glycerin Suppository

Drug: Senna

Drug: Bisacodyl suppository