Encopresis in Autistic Children

One ongoing concern that is increasing in children with Autism is the issue of Encopresis. Encopresis is the repeated passing of feces into inappropriate places, such as clothing or the floor, by a child who is at least 4 years of age either chronically or developmentally (Videbeck, 2004). However, Encopresis is often involuntary, but it can be intentional as well. The involuntary Encopresis stems from constipation that is caused by psychological reasons instead of a medical reason. Whereas, the intentional Encopresis is closely associated with disorders such as the defiant and conduct disorders as well as the disruptive behaviour disorder (Videbeck, 2004).

Understanding and familiarizing one’s self about this condition would have enormous positive effects on both the child and the care giver. It is very important to understand that many children especially those with Autism experience this condition involuntary due to reasons such as anxiety, control, prior bad experience and skill performance (Radford & Anderson, 2010). Firstly, many children dealing with Encopresis get enormous anxiety sitting on a toilet and the action of releasing themselves in the bathroom makes them very anxious. In children with Autism the feeling of anxiety is caused due to the lack of knowledge they have on what feces are and how they are formed thus to them the concept of going to the bathroom is something foreign (Radford & Anderson, 2010). Secondly, the concept of control over our body and actions is something that people learn earlier in life that typically are learnt easily as a human grows older. However, in children on the autistic spectrum the world is unpredictable thus maintaining control over their body is an issue that many of them face. Thirdly, an autistic child who has previously dealt with bad experience while defecating such stomach pain and discomfort would associate

that experience with the place. Meaning, if the child has had a bad experience defecating at a toilet but haven’t had the same experience defecating in their clothes per say, they would then rather defecate in their clothes than the toilet since that means they wouldn’t have to experience any discomfort. Lastly, defecating in a toilet is a learned skill that many learn early in life. However, in a child on the autistic spectrum the lack of feelings such as being relieved or the sense of achievement after defecating would lead them to forget this skill or simply drop it from their routine since they don’t have the. Interest in doing it (Radford & Anderson, 2010).

The statistics on this condition would assist us further in understanding the commonality of both Encopresis and Enuresis. This condition is more common in boys than girls; one percent of five year olds have encopresis. Encopresis can persist with enuresis intermittent exacerbations for years; it is rarely chronic. Most children with enuresis are continent by adolescence; only 1% of all cases persist into adulthood (Videbeck, 2004). Factors such as the limitation on the child’s social activities, effects on self-esteem, degree of social ostracism by peers, and anger, punishment, and rejection on the part of parents or caregivers can greatly affect the course of this condition (Videbeck, 2004).

Various measures can be applied to manage and treat Encopresis. These measures include taking data on the child’s bowel habits, effectively teaching the child about the importance of defecating and through usage of stories explaining to them why they should defecate in the toilet (Radford & Anderson, 2010). Additionally, Encopresis can be treated effectively with imipramine (Tofranil), an antidepressant with a side effect of urinary retention. Both elimination disorders respond to behavioral approaches, such as a pad with warning bell, and to positive reinforcement for continence. For children with a disruptive behaviour disorder, psychological treatment of that disorder may improve the elimination disorder (Videbeck, 2004).

References

Radford, J. O., & Anderson, M. (2003). Encopresis in children on the autistic spectrum. Early Child Development and Care, 173(4), 375-382.

Videbeck, S. (2004). Psychiatric Mental Health Nursing (2nd ed., Vol. 3). Lippincott Williams & Wilkins.